山西省某县级医院2008—2013年老年患者住院费用分析

Elderly Inpatients' Hospitalization Cost in Shanxi Secondary Hospital of China from 2008 to 2013

目的 探讨山西省某县级医院老年患者住院费用的变化特点,为政府制定合理的老年人医疗费用政策提供依据.方法 收集该医院2008年1月-2013年10月、年龄大于60岁的住院患者的住院费用记录,共8 342份,分析老年患者基本特征,住院费用随时间的变化,费用构成随时间的变动,不同年龄、性别的老年患者住院费用差异.结果 老年患者的比例、人数、平均年龄和住院天数逐年增长,人均、日均费用分别增长16.10％、8.90％;药费、治疗费和检查费是结构变动的主要因素,其构成比分别为54.50％、19.80％和11.90％;日均费用随年龄段而增加,70～74岁老年人住院人数、天数及人均费用最高,不同年龄患者的住院天数、人均和日均费用有显著性差异,男性患者的住院天数、人均费用显著大于女性.结论 老年患者住院费用没有得到有效控制,药费没得到控制是其主要原因,体现医务工作者价值的费用呈负向变动,不同年龄、性别的老年患者住院费用存在差异.亟需制定“建立补偿新机制”政策细则,合理控制药费的增长,同时应避免为达到控制药费比例的目的而使其他费用过快增长的现象.此外需制定合理的医疗技术服务价格,完善多层次医疗保障体系.

OBJECTIVE To explore the changing features of elderly inpatients＇ health cost in a secondary hospital of Shanxi Province, and provide a basis tor the changing government to formulate a more rational medical cost policy for elders. METHODS Cost records of inpatients over 60 years old were collected from a secondary hospital between January 2008 and October 2013. Characteristics of inpatients, cost and structure variations were analyzed, and cost in different genders and in age groups were compared. RESULTS The number, percentage, mean age and ALOS （average length of stay） of inpatients increased gradually. Costs per inpatient in- creased 16.10% and daily average cost increased by 8.90%. The main constitutions of health cost were drug cost（54.50%）, treat- ment cost（19.80%） and check cost （11.90%）. Daily average cost increased by age group. The inpatients＇ number, ALOS and costs per inpatient of 70N74 years old were highest. The differences of ALOS, costs per inpatient and daily average cost in different age groups are significant, and the ALOS and costs per inpatient of male are significantly higher than female. CONCLUSION The in- crease of health cost in elderly inpatients was not controlled effectively. The main caused reason was drug. The differences of health cost in elderly inpatients in different genders and age groups were significant. The government should complete the rules of ＂financ- ing mechanism＂ policy and control the health cost reasonably avoiding the unreasonable increase. Besides, the price of health ser- vice should be formulated and the multi-level medical security system should be completed.