单病种付费前后急性阑尾炎住院费用分析

Analysis of the hospitalization expense in acute appendicitis before and after the limitation of single disease payment

目的探讨急性阑尾炎单病种限额付费的意义。方法分析中山市某二甲医院2009年7月至2011年6月出院主要诊断为急性阑尾炎患者的住院费用,按单病种限额付费管理前、后分为两组,采用EXCEL和SPSS15.0统计软件处理。结果单病种付费前组185例,单病种付费后组207例,两组例均住院费用、日均费用、平均住院日、手术费、治疗费及检查费差异均无统计学意义(P均>0.05)。单病种限额付费后药品费低于单病种付费前(t=5.254,P=0.000),化验费高于单病种付费前(t=-3.261,P=0.001)。单病种限额付费前、后非手术治疗和传统手术治疗的例均费用差异无统计学意义,均未超出限额标准;限额付费后微创手术治疗例均费用显著减少(t=2.920,P=0.005),微创手术治疗前、后例均费用均超出限额标准。结论对急性阑尾炎实施单病种限额付费管理可降低微创手术治疗患者的住院费用,现行的限额付费标准实用性欠佳,有必要修订完善,以便实现住院费用的合理控制。

Objective To investigate the significance of single disease payment limitation in acute appendicitis.Methods The hospitalization cost of patients diagnosed with acute appendicitis from July 2009 to June 2011 in a second class A level hospital were analyzed.They were divided into two groups as before and after the limitation of single disease payment,and the data were processed by EXCEL and SPSS15.0 statistical software.Results There were 185 cases in the group before the payment limitation,while there were 207 cases in the group after the limitation.There was no statistical difference in hospitalization cost,daily cost,average days of stay,surgery fee,treatment and examination expense.The drug costs after the limitation of single disease payment were lower than that before the limitation （t=5.254,P=0.000）,while the laboratory fees were higher （t=-3.261,P=0.001）.The differences in non-operative and traditional surgery treatment had no statistical significance before and after the limitation of single disease payment,they didn＇t exceed the standard.The average expense of the minimally invasive surgical treatment was significantly reduced （t=2.920,P=0.005） after the limitation.Conclusion The limitation of single disease payment can reduce the hospitalization cost of the patients with acute appendicitis by minimally invasive surgical treatment,and the current payment standard is necessary to be improved in order to achieve a reasonable control of hospitalization expense.