湖南省浏阳市集里街道社区卫生服务中心住院病例前15位单病种费用分析

Analysis on Expenses of Top 15 Single Diseases among Inpatients in Jili Community Health Service Center in Liuyang City of Hunan Province

目的调查湖南省浏阳市集里街道社区卫生服务中心2008～2010年住院疾病构成与费用情况,为进一步研究提供基线数据。方法采用问卷调查,收集2008～2010年住院病例资料。根据国际疾病分类编码(ICD-10)标化出院记录的第一诊断并系统归类。用Microso Excel 2003和SPSS 13.0等统计软件整理分析住院患者一般情况、出院诊断、医疗费用等。结果①前15位单病种中慢性病9种,急性病6种;平均住院日和次均总费用慢性病均高于急性病(7.8天vs.5.6天,$2 733 vs.$1 551);②急、慢性病次均药费占总费用比例均接近50%;③该中心住院病例治疗模式构成分3种:模式A为纯内科治疗,模式B为内科辅以外科手术治疗,模式C为外科手术辅以药物治疗;④该中心2008～2010年次均总费用冠心病为2 374～2 680元,泌尿系结石为3 268～3 337元,慢性支气管炎为2 452～2 489元;⑤内科次均费用急性病为1 719～1 942元,慢性病为2 386～2 523元;外科次均费用急性病为1 438～1 579元,慢性病为3 044～3 607元;⑥内科平均住院日急性病为5.5～5.8天,慢性病为6.9～7.3天;外科平均住院日急性病为5.9～6.2天,慢性病均为8.3天。结论①湖南省浏阳市集里街道社区卫生服务中心2010年住院病例前15位单病种中有7种疾病次均总费用≥2 000元,均为慢性病,且均高于国家社区卫生中心的平均水平(2 357.6元);②根据住院病例单病种费用构成模式的特点,有针对性地控制住院医疗费用;③近3年次均总费用呈逐年上升趋势的疾病3种(冠心病、高血压和肺部感染),呈逐年下降趋势的疾病有4种(慢性支气管炎、胆囊结石或伴胆囊炎、糖尿病和腹股沟疝);④外科慢性病次均费用高于内科,急性病低于内科;外科急性病和慢性病次均总费用均呈逐年下降趋势;内科急性病和慢性病次均西药费呈下降趋势,但次均总费用却呈上升趋势。⑤平均住院日慢性病比急性病长,外科疾病比内科疾病长。

Object To investigate the constitution and expense of inpatient diseases in Jili Community Health Service Center（JCHSC） in Liuyang City of Hunan Province from 2008 to 2010,so as to provide baseline data for further study.Methods The questionnaire was applied and inpatient records in JCHSC between 2008 and 2010 were collected.The diseases were classified and standardized according to the International Classification of Disease,10th Edition（ICD-10） based on the first diagnosis extracted from discharge records.Such information as general condition,discharge diagnosis and medical expenses etc.were analyzed by using statistic software of Microsoft Excel 2003 and SPSS 13.0.Results a） There were 9 chronic diseases and 6 acute ones among the top 15 single diseases,and both the average hospital stay and per-average hospitalization expense of chronic diseases were higher than those of acute ones（7.8 days vs.5.6 days;$2 733 vs.$1551）;b） Per-average expense of drugs as for both acute and chronic diseases accounted for nearly 50% of the total/general expense;c） There were 3 types of treatment models in JCHSC.Model A was only the internal medicine therapy,Model B was internal medicine assisted with surgery,and Model C was surgery assisted with internal medicine therapy;d） In detail,the total per-average expenses in JCHSC between 2008 to 2010 as for each single disease were as follows： coronary heart diseases（CHD,$2 374 to $2 680）,urinary calculi（$3 268 to $3 337）,chronic bronchitis（$2 452 to $2 488）;e） Per-average hospitalization expenses in internal departments were $1 719 to $1 942 for acute diseases and $2 386 and $2 523 for chronic ones.Among surgical departments,the per-average hospitalization expenses as for acute diseases and chronic diseases were $1 438 to $1 579 and $3 044 to $3 607,respectively;and f） The average hospital stay for acute diseases in internal departments were 5.5 to 5.8 days for acute diseases and 6.9 to 7.3 days for chronic ones.By contrast,those in surgical departments were 5.9 to 6.2 days for acute diseases and 8.3 days for chronic ones,respectively.Conclusion a） In JCHSC,a total of 7 inpatient diseases among the top 15 single diseases in 2010 are all chronic with per-average total expense over $2 000,which is higher than the average level of national CHSC（$2 357.6）;b） According to the features of expense constitution models of the inpatient single diseases,the hospitalization expense should be controlled specifically;c） There are 3 kinds of diseases with yearly-increasing per-average total expenses as CHD,hypertension and pulmonary infection during recent 3 years;meanwhile,4 diseases are with yearly-decreasing per-average total expenses as chronic bronchitis,cholecystolithias or accompanied with cholecystitis,diabetes and inguinal hernia;d） The per-average expenses of chronic diseases in surgical departments are higher than those in internal departments,but those of the acute diseases in surgical departments are lower.Meanwhile,the per-average total expenses as for both chronic and acute diseases in surgical departments present a decline trend year by year.Although the per-average expense on drugs as for both acute and chronic diseases in internal departments show a decline trend,the per-average total expenses indicate an ascending trend;and f） The average hospital stay of chronic diseases is longer than acute ones,while that of the surgical diseases is also longer than internal ones.