2013-2016年兰州市三级医院老年冠心病患者住院费用构成与影响因素分析

Analysis of the composition and influencing factors of hospitalization expenses in elderly patients with coronary heart disease in tertiary hospitals in Lanzhou from 2013 to 2016

目的在医疗费用快速增长,老龄化加重情况下,老年冠心病患者住院费用持续快速增长,给患者家庭和社会带来了很重的经济负担,引起社会广泛关注。本研究分析兰州市包括兰州大学第一医院、兰州大学第二医院、甘肃省人民医院和甘肃省康复中心医院等在内的13所三级医院2013-2016年老年冠心病患者住院费用构成及其影响因素,为合理控制住院费用的过快增长提供参考及建议。方法从甘肃省健康委员会统计信息网络直报系统获取兰州市13所三级医院2013-2016年所有出院患者病案首页信息,根据病案首页信息的完整以及确诊为冠心病等数据纳入标准筛选符合的病例,对数据进行预处理后,运用帕累托法和建立递归系统模型对数据进行分析。结果兰州市三级医院2013-2016年老年冠心病患者住院费用总体呈上升趋势;次均住院费用内部构成中占比较高的依次为医疗服务费(4812.02元)、药费(4083.38元)、诊断费(3109.99元)和耗材费(2201.14元);影响住院费用的外部因素主要是住院天数、是否手术、有无输血和年龄,其总效应绝对值依次为0.337、0.303、0.245和0.155。结论老年冠心病患者住院费用构成中占比最高的为医疗服务费;影响老年冠心病患者住院费用的最主要影响因素是住院天数,有效缩短住院天数是控制住院费用快速增长的关键。

OBJECTIVE With the rapid growth of medical costs and the aggravation of aging,the hospitalization expenses of elderly patients with coronary heart disease continue to grow rapidly,which brings heavy economic burden to the families and society of patients and causes wide attention of the society.This study analyzes the composition and influencing factors of hospitalization expenses of elderly patients with coronary heart disease from 2013 to 2016 in 13 tertiary hospitals in Lanzhou,including the First Hospital of Lanzhou University,the Second Hospital of Lanzhou University,Gansu people’s Hospital,and Gansu Rehabilitation Center Hospital,so as to provide reference and suggestions for reasonably controlling the excessive growth of hospitalization expenses.METHODS The front page information of medical records of all discharged patients from 13 tertiary hospitals in Lanzhou City from 2013 to 2016 was obtained from the statistical information network direct report system of Gansu Provincial Health Committee.According to the complete information of the front page of medical records and the data of confirmed coronary heart disease,the eligible cases were screened.After data preprocessing,pareto method and recursive system model were used to analyze the data.RESULTS From 2013 to 2016,the hospitalization expenses of elderly patients with coronary heart disease in Lanzhou tertiary hospital showed an overall upward trend;the relatively high internal composition of the second average hospitalization expenses was medical service fee(4812.02 yuan),medicine fee(4083.38 yuan),diagnosis fee(3109.99 yuan)and consumables fee(2201.14 yuan).The external factors that affect the cost of hospitalization were hospitalization days,operation,blood transfusion and age.The absolute value of the total effect were 0.337,0.303,0.245 and 0.155 respectively.CONCLUSION The highest proportion of the elderly patients with coronary heart disease is the medical service fee;the main influencing factor of the elderly patients with coronary heart disease is the number of days in hospital,and effective shortening of the number of days in hospital is the key to control the rapid growth of the cost of hospitalization.