上海市某三级甲等医院慢性阻塞性肺疾病的社会经济学的初步探讨

Socioeconomics of chronic obstructive pulmonary disease in a three-A level hospital in Shanghai

目的探讨上海市某三级甲等医院慢性阻塞性肺疾病（COPD）的年度直接经济费用以及费用构成比例,为制定COPD相关的卫生政策提供理论依据。方法收集100例COPD患者1年内因该疾病就诊的次数和所需的各项费用等资料。比较不同严重程度COPD患者间年度就诊次数、所需各项费用以及费用构成比例等的差异,并对COPD患者的经济负担与疾病严重程度进行相关分析。结果 COPD患者的年度总费用为2919（1902~6762）元,其中药费、检查费和诊疗费分别为2245（1497~5210）、431（180~801）、178（98~258）元。不同严重程度组间因该疾病就诊的总费用（χ2=3.701,P=0.029）和药费（χ2=9.423,P=0.009）的差异有统计学意义。各项费用构成比中,药费（70.8%）占最大比例,其次为检查费（14.1%）、氧疗费（5.4%）和诊疗费（3.7%）。患者就医总费用（r=-0.938）、药费（r=-0.319）、机械通气费（r=-0.277）、住院床位费（r=-0.261）、住院护理费（r=-0.255）以及重症监护病房（ICU）住院次数（r=-0.261）、ICU住院费用（r=-0.262）均与COPD的严重程度呈负相关（P值均〈0.05）。结论 COPD患者的病情越重,其年度就医花费、药费、机械通气费、住院床位费、住院护理费以及ICU住院次数和费用就越大。COPD相关的诊疗收费可能欠合理。

Objective To study the direct expense of in chronic obstructive pulmonary disease （COPD） and its proportion in a three-A hospital in Shanghai, so as to provide evidence for the establishing of COPD- related health policy. Methods The annual times of doctor visiting and the total costs of COPD of 100 patients with COPD were analyzed. The times of annual doctor visiting, total costs, and proportions of the costs were compared between patients with COPD of different severities. The correlation between economic burden and the severity of COPD was analyzed by correlation analysis. Results The total direct cost, pharmaceutical cost, examination cost and costs of diagnosis/treatment were 2 919 （1 902-6 762） yuan,2 245 （1 497-5 210） yuan,431 （180-801） yuan, and 178 （98-258） yuan, respectively. Significant differences were found in the total direct costs and pharmaceutical costs between the three groups with different severities （P0.05）. The proportions of the costs were as following： pharmaceutical costs （70.8%）, examination costs （14.1%）, oxygen therapy costs （5.4%）, and costs of diagnosis and treatment （3.7%）. The total direct cost, pharmaceutical cost, ventilation cost, bed cost during hospitalization, nursing care cost during hospitalization, the times and expenditure of ICU care were all negatively correlated with the severities of COPD （r=-0.938, -0.319, -0.277, -0.261, -0.255, -0.261,-0.262, all P0.05）. Conclusion The severity of COPD is positively correlated with the total direct cost, pharmaceutical cost, ventilation therapy cost, bed cost and nursing care cost during hospitalization, and cost and the times of ICU care. The proportions of cost of COPD patients should be further improved in Shanghai for diagnosis and treatment might be unreasonable.