腹股沟疝医保患者住院费用及影响因素分析

Composition and Influential Factors of Hospitalization Expenses in Inguinal Hernia Inpatients Under the Single-disease Payment Standard of Medical Insurance

目的:分析我院接受腹股沟疝手术的医保患者住院费用构成及主要影响因素。方法:采用回顾性研究方法,从HIS数据库中提取接受腹股沟疝手术的医保患者信息,按北京市基本医疗保险腹股沟疝、股疝手术治疗单病种付费管理办法的要求筛选出32例病例,对患者的住院费用构成及主要影响因素进行分析。结果:患者例均住院费用为(5 722.37±2 967.66)元,其中手术费和药品费分别占了45.6%和26.7%,对不同类型疝气补片的选择决定了手术费水平,药费水平则取决于抗感染药的选择和疗程长短。18例患者的住院费低于医保定额支付水平、14例患者高于医保支付水平,2组患者在性别构成、手术费、药费、检查费等项目上差异有统计学意义(P<0.01)。结论:该病种的抗感染药使用存在着不合理现象,医院应制定合适的临床路径和规范的抗感染药治疗方案、明确肠外营养制剂的用药指征,以合理降低医疗费用。

Objective： To analyze the hospitalization expenses in inguinal hernia inpatients under the single-disease payment standard of medical insurance. Method： A retrospective study was performed to analyze the data of inguinal hernia patients who received inguinal hemiorrhaphy in 2006. According to the regulations worked out by the Beijing Medical Insurance Affairs Administration, 32 cases were selected and their medical costs were characterized. Result： The average hospitalization expense in inguinal hemia patients was 5722.37 ± 2967.66 yuan, including surgery cost （45.6%） and drug cost （26.7%）. The surgery cost level depended on the selection of various hernia prosthetic mesh and the drug cost depended on the selection of various anti-infective drugs. The hospitaliztion expenditures were lower in 18 cases than the payment permission in the medical insurance standard but higher in the other 14 cases. The sex composition, surgery cost, drug cost and laboratory cost showed a significant difference between the two groups （P 〈 0.01 ）. Conclusion： Irrational drug-use of anti-infective agents still existed in these cases. It is imperative that medical institutions should draw up a suitable clinical pathway, formulate antimicrobial therapeutic schemes and restrict the use of nutrition agents, which can efficiently decline the hospitalization expenses in inguinal hernia patients.