·1025·
四类患者住
余
波,王孔峰,江学成
221004)
对2007—2011
(解放军第97医
[摘
要]目的
通过对4类患者住院费用的比分析,探
年4类患者的住费用信息进行比较分析。结果职工医保患者均
医保管理部门通过调整结算方
费、新农合及居民医保患者,但
[关键词]人均住院费;职工保;居民医
[文献标识码]A
控制住院天数,国家卫生部改变医药
[文章编号]1008-9985(2012)11-1025-03
AnalysisofHospitalExpensesamongFourKindsofPatients
YUBo,WANGKong-feng,JIANGXue-cheng(FinanceManagementCentre,No.97HospitalofPLA,Xuzhou221004)
[Abstract]Objective
Tocontrolthegrowthofunreasonablehospitalcostsbycomparativeanalysisofhos-Thehospitalexpensesdatawerecollectedandanalyzed
Thetotalhospitalizationexpenditureswere
pitalexpensesamongfourkindsofpatients.Methods
comparativelyoffourkindsofpatientsfrom2007to2011.ResultsConclusion
higherandthegrowthratewaslowerinpatientswithemployeemedicalinsurancethanotherthreekindsofpatients.
ThegrowthofunreasonablehospitalcostscouldbecontrolledifthemedicalInsurancemanagement
departmentadjustedthesettlementmethods,thecountingmethodsandthelengthofstayinhospital,andthestatehealthdepartmentchangedthemedicinemanagementmodel.
[Keywords]
averagehospitalizationexpenditure;employeemedicalinsurance;residentsmedicalinsur-HospAdminJChinPLA,2012,19(11):1025-1027.
1998年我国开始建立城镇职工基医疗保险制2003年
2007年又开始城镇居民医
工作。本文过对2007—2011年4类患者人均住费用对比分析,寻求不同身份患者住院费用的内在律,促进疗保险制度和疗卫生机构深化加强管理,提高
资料和方法资料
“军字资料来自某军
22.1
结
果
人均住院费用比较
5年平在人均
ance;newruralcooperationmedicalscheme
均人均费用职工医保患者于自费、新农合及居民医患者;5年的均环比增幅自费、新农合与居医保者
日均住院费用比较
5年平在日均
均日均费用工医保患者高自费、新农合及居民医保患者;5年的平均环增幅新农合最高,达16.04%,费者达15.1%、居医保患者为14.19%,职工
人均住院药品费比较
5在人均住
年平均人均药品费用职工医患者显著高于自费、新农合及居民医患者,几乎是后二的两倍;5年的平均环比增幅新农合最高,
一号”工程数据库,自、职工医保、新农合、居医保1558患者出院人数中:2007年别
1880人次、1513人次、215次;2009年分别为67732362
7395人次、2214人次、4103人次、687人次;2011年2502人
方法
对2007—2011
日均住院费用、人均住院
[作者简介]余
波,男,主治医师,主任;电话:0516-83349287
医保与非医保患者住院费用构成分析
医保与非医保患者住
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(???????t?l2008-09-13?S???????t?l2008-ll??12)
某二甲医院剖宫产住院费用的分析
龙源期刊网 http://www.qikan.com.cn
某二甲医院剖宫产
作者:曾芳
来源:《中国保健营养 ·中旬
【摘要】:目的:通对宫产患者住院费用分析,找出影响住院用的因素及宫产率 高的原因,并提出合理控制患者住院费用的思路与对策。:用 excel 件建立据库进 数据整理后,用 spss13.0软件进行数分析。结果:剖产率逐年提高;医保覆率有所上 升;住院费用的构成成分中手术费用、药品费用、诊疗用占比重较大;住院天数对住院 费用也有较大影。论:只有通控制药品费用、缩住院天数等才
【关键词】:剖宫产; 住
医疗费用的过增长,给国、位和个人造成沉重的经济负担,近年来我居民收入 长远远低于于医疗消费支出,再加上府投入不足,可以说医疗费用过高已成为制约居民利 用服务的主要因, “ 看贵、看病 ” 问愈演愈烈 [ ]。为了遏制快速增长的医疗卫生费 用,相关部纷纷采取按病种付费结算管理办法,本文选择剖宫这一单病种,围综合医 院单病费及影响因素进行研究,以某二甲医院的剖宫产手术例,对 2012全年 2276例出 院患者医疗费用进行分析。果表明,药物治、诊疗、手术是支配院费用的主要因素, 因此,应该从控制药品费、治疗费、化费、检查费出发来控制剖宫产手术患者住院费用的不 合理增
1 研究对
1.1 研究对象 某二甲医院案室、信息
1.2 方法 运用 SPSS13.0进行统计分析其剖产率、费用支付类、住院费用费用构 成及各因素与住院用之的关等,其中住院用主要从药品费、材料费、手术费、床
2 结果
2.1 剖宫产
2.2 剖宫产手患者费用支付类别情况:保覆盖率较往年有一定的
2.3 运用统计软 SPSS13.0对个因素的因素分析发现年龄、手术时、术前院天 数、住院天数、药品比例与住
[doc] 甲状腺腺瘤病人住院费用分析
甲状腺腺瘤病人
甲状腺腺瘤病人
余祖新0
摘要目的:探讨甲状腺瘤单病种
综合医院的年度报表,
用厦构成.结果:同一病
最低平均相差297倍.结论:提示病人在就医时,应
多了解医疗价格信息,根据需要
医疗费用一
关键词甲状腺腺
中国分类号R197.322文献标识码A文章编号
1001—5329(2002)06—0035—02
Analy,~onthelnl~tientExpenditureofThoseWh0AresufferingFromThyroidTumor//YuZuxin.WangKai-
hua//ChineseH~pitalManagement,2002.22(61:35—36
AbstractObjective:Todiscusstheinpatientexpenditureofthosewhoaresufieringfromthesinglediseaseofthyroid
[LUq1]OTMethod:UsingtheannualtablesofcomprabensJvehospitalsinShanxiPro~,ince,toanalyzetheexpenditureandits
compositionResult:Theexpenditureofthesamediseaseindifferenthospitali
smuchdifferent.andthehighestoneisabout2.97
timeshierthanthatofthelowest.Conclusion:Whenthepatientistobehospitali
zed.itisimportantfhimtoknowtheprice
informationofinedicalser~,ices.andchoosethehospitalaccordingtothenee
dsandpa~ibilities.theref0
expendituregreatly
Keywordsthyroidtumor,hospitalizede呈
上升趋势,其中每位院病人的
涨了14875元,检查
3讨论
甲状腺腺瘤是临床上比较常
对容易,治疗则以手术切除为
治.从病人就医医院的分布
f区,市)属医院占47.00%.
医院为1717%=统结果显示,
医院每例甲状腺腺瘤人平均住
院费占443%,药费
治疗费占4041%.同一病
别,总的趋势是,医院越大,收
人费用高达362948,县属医
竞高达2405.7元,两者相差2.97倍.分析提示,在医疗费用
不断上诜的今天,广-大病人要
了解一些常见病,单病种的医疗
vd22No6(SN2~1)Jun2002
嚣表1甲状腺腺瘸
2所部属医院
2所省属医院
23所地市医院
20所区市医院
86所县属医院
合计
年舒
1997
20呻
93I1.1l
l0lO70
2l5l1.3O
4610.43
29.93
6001n66
I?.23290
1”.?583
940o5.啦
55.3.42
68.0O5.56
83.o74.43
l2l5.76
5毂70
6I6.13
460.17
477.28
64206
33.50
2936
3278
2844)
39.?
3424
895.43
l々2?
33110
35&39
301.64
392.24
表2陕西省]997年2000年
较
49l
60o
1402
10.66
嘲嘲蹶臻
15976894.58551.81
I8751283.07642.06
选择就医卫生行政部门要转变
社会公布医院收费价格和主要疾
医.从而促进医院公,公开公
觉取消不合理的医疗费用.减轻
构要加强价格透明度,按照有关
置公布主要服务项目名称和价格.医院在结算医药费用时.有
义务多种形式向患者提供医疗
觉接受社会监督
平均住院日也是影响医疗费用
量的前提下,碱少不要的住院
病床周转.不仅有利于提高工作
缩高涨的医疗费用,合理分配
状腺腺瘤病凡平均住院日1997
年的10.66天,平住院日同
的变化.但是,病人的住院费用
22.19
8.56
l762
21.94
24.65
2n92
/元撞蕉鞲
24349
39224
707昌0
“775
l503.06
ll29.90
838.05
74889
37684
757.75
41.41
56,25
44.58
4623
30.79
404l
3629.48
2O0860
187928
161980
1223.76
1875.12
低,相反每例病人还
元,涨幅为17.36%.从费用上升的
情乱看,除住院费2000年较1997
年同比每例病人降低11.5I元外,
其它均呈上升态势.其中药费增长
r9025元,手术
4995元.所以,要决医疗费
改革,通过实行药品收支两条线
品流通领域的虚高定价和不正之
法检查,加大社会监力度,抑
医务人员的职业道德育,端正
和提高服务质量.才能使病人真
比较优良的医
参考文献
【】I吕树森外科学【MI.第3版
72一】73
【2]囤家计委,生部于改革医
经济研究,2000.19):56
I3]郭齐祥病种费及质量控
2000.I4):42—43
f收槁H期2002—04—24lc编辑段丽虬l
按照”三个代表”要
程滨朴
中图分类号Rl97323文献标识
t【泽民**关于”三代表”的
政之基,量之源也是档事业发展
二个代表”的重要思想开创医院档
的奠化,教育,侣息服务功
I把为先进生产力
医院档案尾医院工作的料库和信
沿革,制度建设和事业发,使医院每
埘医院在为广太人民群医疗保健
进医院科研发展.科研档对各项科
整理归档.可为后人搞研留下宝贵
对档案信息的求堰进档案信息资源这千潜的生产力.,卫生题品
力,其车身就说明,匡院档
为此,我们在近年来的案收集记
的记载含量清意i}{地加丁能弘扬
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『收稿H期2002—05—08f编辑编艺J
单病种住院费用差异分析
RESEARCH & REPORT 研究与报告
单病种住院
■ 刘丽华① 姚 ① 张
【关键词】卵巢良性肿瘤手术 单病种限价 费用分析
【摘 要】目的:过对卵巢良性瘤手病人住院费用分析,探讨费用差异影响因素,为有的矢开展单病限额付费提实证参。资料与方法:应用医院信息系统2007年1月~2009年12月连续收治的住院病明细资对该病院费用进行分类述,应用方差分析多元线性回对费用差异影因素进行统计分析。结:共获得559份病例,分为4个病情分型组和3个术式组;均住院费用1.05万元、位数0.92万元,最高5.51万元、最低0.29万元;品费例最高(38.62%),手术麻醉费其次(17.20%);多因素分析结果显示不术式、年龄、费别、住院天数、麻醉方式、术前住院日为费用差异影响因素。结论:医改施中,单病种限价付是一种重要的付费式,也是制住院费用的效手段之,单病种费用差异病情术式、人口学信息和疗信相关,单病种费用限额标准的制定需要依据大样本临床病例数据的经济学研究资
Analysis on differences of single disease hospitalization cost / LIU Lihua, YAO Yuan, ZHANG Lili, et al //Chinese Hospitals.-2011,15(1):37-40
【Key words】benign ovarian tumor operation, limited price charge of single disease, cost cost analysis
【Abstract】Objectives: Analyze in-hospital direct cost of benign ovarian tumor operational patients. Explore influencing factors of the same disease in-hospital direct cost. Provide pertinent and practical references for single disease limited price charge. Materials and Methods: Collected and checked patients’ data recorded in the hospital system during Jan 2007 to Dec 2009. Analyze the cost difference applying ANOVA and multivariate linear regression. Results: Obtained 559 patients. Cases were categorized four different syndromes and three operational types. The mean was 10.5 thousand Yuan, median was 9.2 thousand Yuan. The highest was 55.1 thousand Yuan, the lowest was 2.9 thousand Yuan. The percent of drug cost is highest (38.62%), the second is operation and anesthesia cost. Multivariate linear regression analysis showed that operational type, age, charge, length of stay, anesthesia method and pre- surgical length of stay were independent predictors of cost. Conclusions In the process of new health reform, limited price charge of single disease is one of important charge. It is also one way of controlling in-hospital cost effectively. Cost difference was concerned with patients’ demographic data, treatment and state of an illness. When we identify limited price charge standard of single disease, the full sample data analysis and economic estimate is necessary.
Author’s address:Hospital Management Research Institute, General Hospital, PLA, No.28, Fuxing Road, Beijing, 100853, PRC
1 引言
医疗费用持续增长成世界各国面临的共同问题,长期以,单病种价付费是控制医疗费用的有效手段之一,目前,我国多省份选择部病种试行[1-2]。北市自2004年起,针对医保病人开展了包括性阑尾炎手术疗[3]、剖宫产在的21种病种的限额,有效控制了此类病种的住院费用。但在具体实施中,由于对费用限额可能存在诸影响因素究不足,定价标
付费方式流于形式[4],使许多医
卵巢良性囊切除术是北京单病种限价管理病种之一[5],本文通过对市某三甲医院近3年收治的全部病例行究,析该病种的费差异及其影响因素,为制定单病
出院第一诊断为卵巢良肿瘤(ICD 10= D27)并受手术治疗的全部病例,对据行查,排除转科、二次及以上手术、不合
2.2 资
按照北京本医疗保险对卵良性肿瘤手术治疗单病种限价付费的手术类别和病种别,结合564份病例的病情状况、手名称,对其行病情分型和术分类,并与北京市现行单病种限额标准
2 资料与方法
2.1 资
从北京市某三甲医院ODS(Operational Data Store,操数
基金项目:国家然科学基金面上项目,于ODS的HIS
①解放军总医院医院管理
②中国医学科学院学信息研究所,100020 北京市朝阳区雅宝路3③国
2.3 住院
对不同病情分型组和术式组住院费(对数转换值)
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指标和5项不同诊疗指标间住院费用(
素混杂偏倚,进一步对进行多因素分析。设住院费(对数转换)为因变量,有显著差异的病术和人学指标、诊
3 结果
3.1 病例采
共收集2007年1月~2009年12月期间住院的巢良性肿瘤手治疗病例691例,从医院信息统采集
2.4 住院费
鉴于住院费用差
表1 559份病例不
排除132例,入559例,纳入病例平年龄37.25岁,
3.2 病例分
559份病包4个病情分型组和3术式组,结果见表1。从病情分型看,单纯良肿瘤病例最,415例,其余3组病例数目相当;从术式看,腹腔手术病最多,300例,开腹手术、经阴道手术病例分别有144例、115例;综合
表2 559份病例不同分型术式的实际
表3 564份病例住
43.11%。
与北京市单病种限标准比较表明,4个情分型与式组的次均费用、全麻术均
从表3可知,81.03%患者(453例)费用中在0.5~1.5万元之间,近5%的病(23)费用超过2.25万元;住院费用呈正
住院费用构成中药品最多、占38.62%,手术麻醉其次、占17.20%,加
表4 559份病例住院费用(万
表5 559份病例4种分型3种术式次
3.3 住院
两因素析因设计方差分,表明不同病情分型组、式组间住院费存在显著性差异,两因素交互有著差异。费用两比较表明:单纯卵巢良性肿
p=0.515。
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RESEARCH & REPORT 研究与报告
病病例费用最高,但与合并子宫平滑肌瘤例无显著性差异;
病例年龄集中于20~50岁,377例、占67.44%。小于20岁病例费用为0.98万元,20岁以上病例用虽龄增长皆有增高。各年组费用两两比较显示:10岁以下组费与其它各组有显著性差异,10~50间的4组与50岁以上的3组病例间的用均有显著性差异,10~50岁间的4病例之间,只有20岁组
559份病例不同婚姻况、费别之间住院费用在显著差异,婚病例费用高于未婚病例,费例费高于其他别、医保病例与其它病例的
单因素t检、方差分析表不同住院天数、术前住院日、出院诊断数量住院费用有显著性差异,住院天数、前院日长,住院费用长趋势明显,出院诊断数量各组
北京某三级医院收治良性巢肿瘤切
研究发现,多素影响卵巢良性肿瘤手病人住院费用。按照各影响因素在多元线性回归中标准回归系大小序,依次为住院天数、麻醉方法、年龄、前住院日、诊数量,别为0.567、0.251、0.174、0.154、0.145。因此减少病人住
年龄是影响住院费用的因素之一,
纯卵巢良性肿瘤病例均龄33.84岁,腹腔镜手术病例平年龄31.68岁,分别在不同病情分型与术式组中最低。相应,单纯卵巢性肿瘤病费用在病分型中低,腹镜手术病例费用在术式组中最低。进一步分析发育龄期病人(13~45岁397人)行腹腔镜术,其中卵肿剥除手术病例229例,占57.68%,次均住院费用0.86万元,低于育龄期病巢囊肿剥除
表6 559份病例不同年龄组住
表7 559份病例不同年龄组住
3.4 多因素
选择单因素分析有显差异病情分型、术式、年龄、婚姻状况、费、住院天数、术前住院日、麻醉方式、出院诊断数量9个指标为自变量,对住院费作多元线回归分析,果见表9。多元
2
表8 559份病例5项诊疗指
4 讨论
本文参照国内外部分病种住费用影响
中国医院.2011年1月
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表9 住院费用差异影
参考文献
用低等优点,临床应用
卵巢良性囊肿切术是北京单病限价管理病种之一,与付费标准比较,发559病例与之相同的4种分组次均费用及全麻手术均高于限价值(表2)。其中,单纯卵巢良性肿瘤开腹手术例99例、均费用1.23元,比限标准高171.11%;单纯卵巢良性肿瘤腹腔镜手术病例241例、次均费用0.86,比限价标准57.41%。相比较,4种分手术费用实际值限价标准相差较。可见,手术费不是次均用高于限价标准的最大影响素。分析住院费用构成,其中药品费最多、级差最大,近3万元,是费用高于限价标准最大影响因素,其主要预防性抗菌药物用类相关,本文病人治疗并未严格执行卵巢性肿瘤临床路径,所以用药多样,病情相同的病人药费也有差
晓意愿会逐步加强,病种限价付费表明能减少不必要疗费用、提高医疗质量,加额费疾病种类,积极推行单病种限价付
5.2 单病种费用
单病种费用受多方面因素影响,:病人自身因素、诊疗因素、管理因素等;时,制订单病种费准需要考虑限额的区间性或参数调整性。我国实施病种费,还要加大相关配套政策制定,如:药费控制办法,筹资与保障体制的完
5.3 本
制订单病种限额标准需要依托样本数据和经济学评价研究,基于单一院的顾性研究人疗特征较多、相应分组较多,每组病人例数相较少,对分析果的可靠性有一定响。本研究尚待扩大样本含量,开展前瞻性
准的实用性
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新医改实施中,医疗服供需双方
[收稿日期 2010-09-25](责任编辑 郝秀兰)
·40· Chinese Hospitals,Jan.2011,Vol.15,No.1
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