基于病例分型和是否手术的住院费用标准化方法

Standardization method for hospitalization cost analysis based on distribution of disease-case classification and operation

目的建立基于病例分型和是否手术的住院费用标准化方法,以使不同费别住院费用之间具有可比性。方法对广州某三甲医院2007年度36448例出院病例住院费用进行多因素回归分析、标准化处理和分层分析。结果患者主要疾病治疗天数、是否手术、病例分型、患者年龄、性别、费别等是影响住院费用的主要因素。通过病例分型和是否手术进行标准化后,人均住院费用由高到低依次为:特需医疗患者、丙市医保患者、乙市医保患者、自费患者、甲市医保患者、公费医疗患者。进一步分层分析人均住院费用,甲市、乙市、丙市自费患者人均住院费用均低于相应地区医保患者。结论综合比较患者住院费用时,需先按主要影响因素进行标准化,否则可能得出错误结论。对出现多个混杂因素时,宜采用分层分析的方法。

Objective To establish the standardization method for hospitalization cost analysis based on the distribution of disease-case classification and operation, and make the different charge-type comparable. Methods The data of hospitalization cost of 36 448 inpatients from a general hospital in Guangzhou during 2007 was analyzed using multiple linear regression. Standardization method and subgroup analysis were also used. Result Days of main disease cures, opera- tion, disease-case classification, age, sex, and so on, are the primary influence factors：After standardization, the ex- pense means＇from high to low in turn are the special requirement medical service, medical insurance of the oity C, medical insurance of the city B, the self-supported; medical insurance of the city A, the;expense for free respectively. The expense means of self-supported patients is lower than that of the corresponding medical insurance supported patients. Conclusion The standardization based on main effects should be applied, for the comparison of hospitalization cost between the hospitals in case of wrong results. The subgroup analysis is necessary if there are confounders.