单病种住院费用差异分析

Analysis on differences of single disease hospitalization cost

目的：通过对卵巢良性肿瘤手术病人住院费用分析，探讨费用差异影响因素，为有的放矢开展单病种限额付费提供实证参考。资料与方法：应用医院信息系统中2007年1月～2009年12月连续收治的住院病人明细资料对该病种住院费用进行分类描述，应用方差分析和多元线性回归对费用差异影响因素进行统计分析。结果：共获得559份病例，分为4个病情分型组和3个术式组；次均住院费用1．05万元、中位数0．92万元．最高5．51万元、最低0．29万元；药品费比例最高（38．62％），手术麻醉费其次（17．20％）；多因素分析结果显示不同术式、年龄、费别、住院天数、麻醉方式、术前住院日为费用差异影响因素。结论：新医改实施中，单病种限价付费是一种重要的付费方式，也是控制住院费用的有效手段之一，单病种费用差异与病情术式、人口学信息和诊疗信息相关，单病种费用限额标准的制定需要依据大样本临床病例数据的经济学研究资料。

Ohjectives： Analyze in-hospital direct cost of benign ovarian tumor operational patients. Explore influencing factors of the same disease in-hospital direct cost. Provide pertinent and practical references for single disease limited price charge. Materials and Methods： Collected and checked patients＇ data recorded in the hospital system during Jan 2007 to Dec 2009. Analyze the cost difference applying ANOVA and multivariate linear regression. Results： Obtained 559 patients. Cases were categorized four different syndromes and three operational types. The mean was 10.5 thousand Yuan. median was 9.2 thousand Yuan. The highest was 55.1 thousand Yuan. the lowest was 2.9 thousand Yuan. The percent of drug cost is highest （38.62%）, the second is operation and anesthesia cost. Multivariate linear regression analysis showed that operational type, age, charge, length of stay, anesthesia method and pre- surgical length of stay were independent predictors of cost. Conclusions In the process of new health reform, limited price charge of single disease is one of important charge. It is also one way of controlling in-hospital cost effectively. Cost difference was concerned with patients＇ demographic data, treatment and state of an illness. When we identify limited price charge standard of single disease, the full sample data analysis and economic estimate is necessary.