恶性肿瘤终末期患者住院费用与影响因素研究

A Study on the Cost of Hospitalization and Its Influencing Factors for Patients with Terminal Malignant Tumor

目的分析晚期恶性肿瘤死亡患者不同时期住院费用情况,寻找影响肿瘤终末期患者住院费用的影响因素,为肿瘤防控及医保政策提供科学依据。方法选取2015年1月1日-2019年12月31日某院肿瘤科晚期恶性肿瘤死亡患者为研究对象,回顾总结其分别在距离死亡月数(即以月为单位距离最终死亡时间)的住院总费用,兼顾住院天数、西药费、中成药费、中药费、材料费、化验费、治疗费、检查费进行统计学分析,利用多元线性回归分析及岭回归分析找到影响肿瘤终末期患者住院费用的影响因素。结果肿瘤患者住院费用与用药情况均呈线性回归关系。距离死亡1月~3月内的患者的住院总费用与住院天数有很大相关性,对距离死亡1月内和距离死亡3月以上的患者的总费用的影响无统计差异;化验费和治疗费对所有肿瘤患者住院总费用有很大的相关性;检查费只对距离死亡1月内的患者的住院总费用有较大影响,对距离死亡1月到3月内和距离死亡3月以上的患者的总费用的影响无统计意义。结论用药情况、化验费和治疗费对医疗费用的影响较大,住院天数及检查费对肿瘤终末期不同时间段医疗费用的影响不同,应加强医疗技术的经济评估,指导肿瘤治疗的成本效益分析,有助于医疗资源的合理分配。

Objectives To analyze the hospital expenses of patients with advanced malignant tumor death at different periods,find out the influencing factors of the hospital expenses of patients with terminal malignant tumor,and to provide scientific basis for tumor prevention and control medical insurance policies.Methods To select patients of a hospital from January 1 st 2015 to December 31 st 2019 with advanced malignant tumor death as the research object,its death months respectively in the distance(that was the distance for the unit with the month end time of death) of the total cost in hospital,both hospitalization days and western medicine fee,expenses for Chinese patent medicine,traditional Chinese medicine,cost of raw materials,tests,treatment examination for statistical analysis,using multiple linear regression analysis and ridge regression analysis to find the influence factors of tumor in patients with end-stage hospital expenses.Results There was a linear regression relationship between hospitalization cost and drug use.The total hospital expenses of patients within one month to three months from death were significantly correlated with the length of hospital stay,and had no statistical significance on the total hospital expenses of patients within one month from death or more than three months from death.There was a great correlation between the cost of laboratory and treatment to the total cost of hospitalization for all cancer patients.The examination fee only had a great influence on the total hospital expenses of patients within one month from death,but had no statistical significance on the total hospital expenses of patients within one month to three months from death and patients more than three months from death.Conclusions Drug use,laboratory fees and treatment fees had a great impact on medical expenses,and hospitalization days and examination fees have different impacts on medical expenses at different stages of tumor terminal stage.Therefore,economic evaluation of medical technology should be strengthened to guide cost-benefit analysis of tumor treatment,which was conducive to rational allocation of medical resources.