城市医院医疗费用上涨影响因素结构方程模型分析

Structure Equation Model Analysis about Urban Hospital Medical Cost Increase Influence Factors

目的定量研究城市医院医疗费用上涨影响因素及因素间相互作用,以期寻求控制城市医院医疗费用不合理上涨的策略和措施,为解决医疗费用增长过快问题提供决策依据。方法采用带观测变量结构方程模型进行医疗费用上涨影响因素的经济学分析。结果①政府财政投入减少会导致医疗费用上涨,财政投入增加1亿元,导致人均医疗费用下降0.334元,导致城市医院总医疗费用减少39.6亿元;②医疗费用的增长存在不合理性,GDP增长,商品零售价格指数增长,医疗费用反而下降;③医疗费用增长与居民收入水平以及患者特征有关,人均收入增加1元,人均医疗费用增长0.088元;患者住院次数占门急诊次数百分比越高,医疗费用增长量越低;④医疗费用上涨与医生工作效率基本无关,主要是次均费用的增长导致。结论增加政府财政投入,可较好地控制医疗费用上涨;同时,增加政府财政投入,控制医疗费用上涨主要是通过控制单位医疗费用上涨而实现。建议各级财政对卫生事业的投入保持与GDP增长同步并略高于GDP增长水平,每年递增10%左右。

Objective To provide decision-making basis for solving the medical expenses overgrowth problem by quantitative research of increases influence factors in urban hospital medical treatment fee and the factor interactions. Methods Using the observation variable structure equation model to analyze rising medical costs influence factors. Results （1） The government reducing financial input would lead medical costs rise, financial investment increase 1 billion yuan, resulting in per capita medical costs decline 0. 334 yuan and urban hospital medical costs reduced total 39.6 billion yuan . （2） Medical treatment cost growth is irrational. GDP and retail price index is grow- ing, but medical treatment charge is fallen. （3） Medical expenses growth is related to the income level and the patient characteristics, per capita income increase one yuan, the per capita medical expenses growth 0. 088 yuan. the percentage of the number of admissions by number of clinical visits is higher, medical expenses growth is lower; （4） Medical treatment fee increases is irrelevant with the work efficiency of doctors. Conclusion Controlling medical expense rise mainly controls medical treatment fee increases. The government financial input on health service should be keeping growth simultaneously with GDP and slightly higher level, increasing input growth around 10% each year.