急性阑尾炎单病种住院总费用的变异性分析

Variation Analysis of Total Hospitalization Cost for Single-Diagnosed Disease of Acute Appendicitis

目的探讨不同类型急性阑尾炎单病种在三甲医院住院费用的变动情况,为确定分层社保报销额度提供依据。方法收集四川大学华西医院胃肠外科中心2011年1～4月(单病种收费前)和2012年1～4月(单病种收费后)期间住院手术治疗的所有急性阑尾炎病例,将纳入病例分成低风险组(单纯性、化脓性、坏疽性)和高风险组(穿孔性、脓肿形成、合并妊娠)共6种类型,分析其总住院费用与不同类型的关系以及实行阑尾炎单病种收费后住院总费用的变化情况。结果共纳入90例急性阑尾炎病例,其类型与住院天数和住院总费用均呈显著正相关。低风险组3种类型可控制平均住院总费用在10 000元以内。敏感性分析结果显示,实施单病种收费前,当额定住院总费用上限达6 000元时,按上述风险分组方式即可呈现正相关(r=0.442,P=0.003)。实施单病种收费后同期病例比较,两组住院天数的构成比差异无统计学意义(P=0.108),但住院天数<5天的比例从45%上升至64%,住院天数≥10天的比例从17%下降至4%,住院时间有缩短趋势;两组住院总费用构成比的差异亦无统计学意义(P=0.114),但住院总费用≥9 000元的比例从32%下降到13%,住院总费用有降低的趋势。结论对于在三甲医院住院治疗的急性阑尾炎低风险组病例,以6 000元为额定社保报销限度为宜。而高风险组其住院总费用变异较大,其是否按单病种额定收费以及额定住院总费用如何设定均需进一步研究。实行单病种收费有助于缩短住院时间和降低住院总费用。

Objective To investigate the variation of total hospitalization cost for single-diagnosed disease of different types of acute appendicitis in a three-A hospital, so as to provide evidence for the reimbursement amount of social medical insurance. Methods All patients with acute appendicitis who had surgery treatment during January-April 2011 （before implementing the fee system for single-diagnosed disease） and January-April 2012 （after implementing the fee system for single-diagnosed disease） were collected in this study for analysis. According to the types of acute appendicitis, the patients were stratified into the low risk group （simple, suppurative and gangrenous） and the high risk group （perforative, abscess- formed and pregnancy-combined）. The correlation between total hospitalization cost and types of acute appendicitis, as well as the changes of total hospitalization cost after implementing the fee system for single-diagnosed disease were analyzed. Re- suits A total of 90 eligible patients were included. The disease types were positively correlated with hospital stays and total hospitalization cost. All three types in the low risk group could control the average total hospitalization cost within RMB 10 000 yuan. The results of sensitivity analysis showed that, before implementing the fee system for single-diagnosed disease, the total hospitalization cost up to RMB 6 000 yuan could be positively correlated with the above risk stratification （r=-0.442, P=0.003）. After implementing the fee system for single-diagnosed disease from January to April 2012, the constituent ratio of hospital stays, compared with that in the same period of 2011, had no significant difference （P=0.108） between the two groups; but the ratio of hospital stays （less than 5 days） increased from 45% to 64%, and the ratio of hospital stays （greater than or equal to 10 days） decreased from 17% to 4%, indicating a tendency of shortening hospital stays. Also, the constituent ratio of total hospitalization cost had no significant difference （P=0.114） between the two groups; but the ratio of total hospi- talization cost （greater than or equal to RMB 9 000 yuan） decreased from 32% to 13%, indicating a tendency of lowering total hospitalization cost. Conclusion The low risk group of acute appendicitis, RMB 6 000 yuan should be rated as the rational reimbursement amount of social medical insurance. The total hospitalization cost for the high risk group is quite various, so the further studies are needed to investigate the feasibility of the fee system for single-diagnosed disease as well as the rating amount of total hospitalization cost. The implementation of the fee system for single-diagnosed disease is helpful to shorten hospital stays and reduce total hospitalization cost.