食管癌患者住院费用影响因素分析

Influence factors of hospitalization expense among esophageal cancer patients

目的探讨食管癌患者住院医疗费用影响因素,为控制医疗费用不合理增长、完善医疗保障制度和制定食管癌防治规划提供参考依据。方法对山西省某三甲综合医院2002年8月—2011年12月食管癌患者住院费用进行分析,采用多重线性逐步回归分析法分析影响食管癌患者住院费用因素。结果 2002年8月—2011年12月该院1 819例食管癌患者平均住院天数为19 d,平均年龄为(58.47±8.20)岁,77.74%的患者为农民,病理类型以鳞癌为主,占82.90%;人均住院费用为(19 249.78±15 472.23)元,且逐年增加,平均增长速度为15.28%;住院费用的主要影响因素依次为:药品费所占总费用比例、住院天数、有无医疗保险、有无合并症、病理类型、疗效、年龄;医保患者的医疗费用高于无医保患者(F=135.609,P<0.001)。结论采取综合措施控制住院费用,尤其是加强对药品费用的控制管理和缩短住院时间是目前降低食管癌患者住院费用、减轻疾病负担最有效可行的手段。

Objective To explore influence factors for hospitalization expense among esophageal cancer patients and to provide a basis for controlling unreasonable increase of hospitalization expense. Methods Inpatient data of esoph- ageal cancer patients were collected from a general hospital of grade three in Shanxi province between August 2002 and December 2011 and were descriptively analyzed for the composition and change trend of hospitalization expense during the period. Potential influence factors were examined with univariate and multiple stepwise regression analysis. Results A total of 1 819 esophageal cancer inpatients were admitted in the hospital during the period. The average age of the inpa- tients was 58.47± 8.20 years and 77.74% of them were farmer. Squamous cell carcinoma accounted for 82. 90% of the patients. The mean time of the hospitalization was about 19 days. The hospitalization expense per inpatient was 19 249. 78 ±15 472. 23 RMB Yuan. An annually increasing trend was noticed for the expense, with an average annual increase of 15.28%. The main influence factors for the expense were age, the proportion of drug expense, hospitalization time, whether having medical insurance, with or without complication, pathological type of the tumor, treatment outcome, and the age of the inpatient. In particular, hospitalization expenditure of the patients with health insurance was higher than those without the insurance （ F = 135. 609, P 〈 0. 001 ）. Conclusion Comprehensive measures need to be taken to con- trol hospitalization expense. Drug expense and hospitalization time should be controlled to decrease hospitalization expense among esophageal cance patients.