综合性医院大额住院医疗费用分析

Analysis on mint fee-for-service in comprehensive hospital

目的分析综合性医院大额住院医疗费用构成及影响因素,为控制医疗费用的过度增长提供依据。方法选择武汉市某大型综合医院2004年9月1日至2005年2月28日出院患者的病历首页,选取总费用在10万元以上的病例232例,对其总费用及影响因素进行统计分析。结果大额住院费用以药费所占比例最大,占53.34%,其次是治疗费占20.12%,检查费占8.16%,手术费占5.27%,床位费仅占1.99%。不同住院天数的人均费用有显著性统计学差异(P<0.001),住院天数越长,人均总费用越高。随着住院天数的增加,药费在人均总费用的构成中所占比例明显增高,而检查费、治疗费、手术费在人均总费用的构成中所占比例逐渐降低。不同科室的患者,其人均总费用有显著性统计学差别(P<0.05),其中最高的是内科242109.7元,其次是ICU病房227795.54元,最低的是外科143252.34元。从付款方式来看,公费医疗患者仅占10.35%,住院天数和人均费用高于其他2组,但差别无统计学意义。危重患者及死亡病例住院时间长,费用高。结论减少无效、低效住院时间,控制过度服务,降低药费消耗比例,加强慢性病的预防与控制是降低大额医疗费用的有效途径。

Objective We analyzed the composition and influence factors of mint fee-for-service in Comprehensive hospital in order to provide the gist for controlling the excessive enhancement of fee-for-service. Methods Selected the first page of the patients who had already dismissed hospital from 1^st Nov. 2004 to 28^th Feb. 2005 of some all-round hospital in Wuhan city, and selected 232 cases whose total fee-for-service over ￥100, 000 and analyzed the total fee and its influence factors. Results The proportion of the drug expense is the highest in mint fee-for-service （53.34%）, the second is the treatment expense （20. 12%）, examination fee （8.16%）, operation fee （5.27%） and bed fee （1.99%） subsequently. There is significant statistics diference between the days being in hospital and mean expense （P〈0. 001）, the clays longer the patients are in hospital, the mean expense higher they expend. Along with the days increasing of the patients are in hospital, the proportion of the drug expense increase obviously, while the treatment expense, examination fee and the operation fee decrease gradually in the total fee of mean expense. There is significant statistics difference of the total fee between different departments （P 〈 0. 05）, the highest is internal medicine （￥242109. 7）, the second is ICU （￥227795.54）, and the lowest is surgery （￥143252. 34）. According to the mode of payment, the patients of public expense only occupy 10.35%, the days and mean expense are higher than other two groups, but no statistics difference. The days of patients who is severe and dying being in hospital are long, so the expense is higher. Conclusion The effective methods to decrease the expense of mint fee-for-service are decreasing the time of inefficacy or lower effect being in hospital, controlling the excess service, decreasing the proportion of drug expense and enhancing the control and prevent of chronic diseases.