1996—1997年全国铁路医院20个住院病种费用效益分析

Analysis of Hospital Expense and Benefit of 20 Kinds of Inward Diseases in Nationwide Railway Hospitals from 1996 to 1997

目的 分析住院病种费用效益变动趋势 ,探讨控制医疗费用不合理过度增长的有效途径。方法 对1996— 1997年全国铁路医院 2 0个住院病种 ,共 15 3 396例住院病人的例均费用、例均药品费、药品费用占总费用的百分比、例均其它费用 4项指标采用RSR进行动态对比综合分析。结果 ① 1997年与 1996年相比 ,例均住院费用、例均药品费与药品费占总费用的百分比均明显上升 (P <0 .0 5 )。② 2 0个住院病种费用效益 ,除甲状腺癌和急性阑尾炎外 ,其余 18个病种均较 1996年有所下降。③例均费用中 ,仅结肠癌、甲状腺癌 2个病种略有下降 ,其余18个病种例均费用均有上升 ,其中以急性肾炎上升尤甚 ,达 114 12 %。④总费用效益 ,1997年较 1996年明显下降(P <0 0 0 1)。结论 建立城镇职工基本医疗保险制度 ,开展循证医学实践和卫生技术评估 ,实施单病种医疗费用控制 。

Objective To analyse the variation tendency of hospital expense and benefit, inquire into the effective method to take control of the inappropriate medical expense over increment. Methods The following indices, average case expense, average case medicine expense, the percentage of medicine expense in total expense, other average case expense, that were got from 20 kinds of inward diseases in nationwide railway hospitals from 1996 to 1997, total 153 396 cases of inward patients were collected and the RSR statistics was used to make dynamic comparison and comprehensive analysis. Results (1) Compared with 1996, the average case expense, average case medicine expense, and the percentage of medicine expense in total expense apparently ascended in 1997 ( P <0.05). (2) The inward expense and benefit, except that in thyroid carcinoma and acute appendicitis, in 18 kinds of diseases descended. (3) The average expense, only that in colon carcinoma and thyroid carcinoma slightly descended, all that in other 18 kinds of diseases were ascended, especially in acute glomerulonephritis, rose up to 114.12%. (4) Total expense and benefit were descended in 1997 compared with that in 1996 ( P <0.001). Conclusion The setting up city and town workers′ basic insurance system, under taking the practice of evidence based medicine and health technology assessment, play an important role in the control of inappropriate medical expense over increment.