宁夏地区住院回族糖尿病患者医疗费用影响因素15年对比分析

Comparison of the influencing factors of medical cost for hospitalized diabetics in Ningxia area within 15 years

目的:观察宁夏地区回族糖尿病患者医疗费用分布情况,分析其影响因素。方法:①对1990-01-01/1994-12-31和2000-01-01/2004-12-31在宁夏回族自治区宁夏医学院附属医院和银川市第一人民医院内分泌科住院的回族糖尿病患者1434例病历资料进行分析,其中男827例,女607例,平均年龄(46±17)岁,平均病程(6.8±5.7)年。患者的直接医疗费用资料源自上述患者住院时的收费情况一览表。1990-01-01/1994-12-31收住此两家医院患者601例,其中合并慢性并发症、合并大血管并发症、合并微血管并发症患者占56.5%,55.4%,44.6%。2000-01-01/2004-12-31收住此两家医院患者833例,合并慢性并发症、合并大血管并发症、合并微血管并发症患者占74.3%,49.5%,50.4%。②依据中华医学会糖尿病分会统一制定的调查表格,对患者基本情况、本次入院情况以及医疗费用的情况等项目进行整理。结果:①有无并发症住院回族糖尿病患者住院费用对比:1990/1994无并发症和有并发症回族患者人均发生住院直接医疗费用分别为(1722±88)和(3002±98)元;在2000/2004相应医疗费用为(3151±118)和(6742±124)元。15年间无并症医疗费用增长率明显低于有并发症者[(83±14)%,(125±12)%,P<0.01]。②大、微血管并发症住院回族糖尿病患者住院费用对比:1990/1994伴有大血管和微血管并发症回族患者人均发生住院直接医疗费用分别为(3179±104)和(2760±145)元;2000/2004相应医疗费用分别为(8841±205)和(4676±105)元。15年间伴大血管并症患者医疗费用增长率明显高于微血管并发症患者[(177±15)%,(70±6)%,P<0.01]。③宁夏住院回族糖尿病患者不同系统并发症住院医疗费用分布情况:1990/1994合并心血管病变患者的住院医疗费用居首位[(3246±147)元],其次是合并脑血管并发症患者和肾脏病变、糖尿病足患者[(2996±144),(2965±128)元],周围神经病变患者医疗费用最低;2000/2004合并心血管病变患者住院医疗费用仍居首位[(10430±149)元],其次为合并肾脏病变和糖尿病足患者[(7039±178),(6188±158)元],周围神经病变患者医疗费用仍最低。结论:合并并发症为宁夏地区回族住院糖尿病患者医疗费用增长的主要因素,且大血管并发症影响最大。

AIM： To understand the medical cost distributed situation of the hospitalized diabetic patients in Ningxia Hui Autonomous Region and analyze the influencing factors. METHODS： （1）A total of 1 434 case files were enrolled from the diabetic patients of Hui tribe hospitalized in the Department of Endocrine, the Affiliated Hospital of Ningxia Medical College and the First People＇s Hospital of Yinchuan, including 827 males and 607 females aged a mean of （46±17） years. The average course of disease was （6.8±5.7） years. The direct medical cost of patients accorded to the charge catalogue of hospitalization. There were 601 patients hospitalized from January 1990 to December 1994, 56.5% of them with chronic complication, 55.4% with macrovascular complication, and 44.6% with microvascular complication. In 833 patients who hospitalized from January 2000 to December 2004, 74.3% of them with chronic complication, 49.5% with macrovascular complication, and 50.4% with microvascular complication. （2）The general condition, hospitalized status and medical cost of those subjects were arranged with the questionnaire formulated by the Chinese Medical Association Diabetes Branch. RESULTS： （1）Comparison on the medical cost of diabetic patients with or without complication in hospitalization： The per capita cost of patients with or without complication were （1 722±88） and （3 002±98） yuan in 1990-1994, （3 151±118） and （6 742±124） yuan in 2000-2004. In the past 15 years, the medical cost increased obviously in patients with complication than those without complication [（83±14）%, （125±12）%, P 〈 0.01]. （3）Comparison on the medical cost of diabetic patients with macrovascular and microvascular complication： The direct medical cost of patients with complications were （3 179±104） and （2 760±145） yuan in 1990-1994, （8 841±205） and （4 676±105） yuan in 2000-2004, respectively. In the part 15 years, the patients with macrovascular complication increased the medical cost compared with those of microvascular complication [（177±15）%, （70±6）%, P 〈 0.01].（3）Medical cost of diabetic patients with different system complications： In 1990-1994, the medical cost ranked first in patients with cardiovascular pathological change [（3 246±147） yuan], then in those with cerebrovascular complication, renal lesion and diabetic foot [（2 996±144）, （2 965±128） yuan], the lowest in those with peripheral neuropathy; In 2000-2004, the patients with cardiovascular pathological change still ranked first [（10 430±149） yuan], the next was those with renal lesion and diabetic foot [（7 039±178）, （6 188±158） yuan], and the those with neuropathy turned into the lowest expense. CONCLUSION： The merge of complications is the primary factor for the increased medical cost of diabetic patients hospitalized in Ningxia area, and macrovascular complication is the most important factor.