参加城镇职工基本医疗保险的慢性病患者住院费用的影响因素调查

Factors Influencing Hospitalization Expenses of Chronic Disease Patients Registered with Basic Medical Insurance for Urban Workers

目的探讨参加城镇职工基本医疗保险(城保)的慢性病患者住院费用的影响因素,重点探讨使用高值医用耗材对其的影响,为控制慢性病患者住院费用、降低慢性病患者经济负担提供参考。方法于2012年10月,通过江苏省南京市医疗保险结算管理中心数据库,收集2010年使用了高值医用耗材(单价≥500元)的6 035例城保参保慢性病患者的住院资料,收集内容包括患者的年龄、性别、病种、就诊医院等级、一年内住院次数、入院时间、出院时间、住院费用及高值医用耗材费用等。计算医用耗材费用比,采用多元逐步回归分析法探讨不同病种慢性病患者住院费用的影响因素。结果不同病种慢性病患者的总医用耗材费用比为19.7%(36 537 530.0/185 441 167.2),其中恶性肿瘤放化疗、老年性白内障、冠心病及糖尿病患者的医用耗材费用比分别为13.1%(17 898 103.0/136 691 925.3)、38.6%(2 510 037.0/6 500 016.5)、40.9%(14 957 320.0/36 541 867.0)及20.5%(1 172 070.0/5 707 358.4);不同病种慢性病患者的医用耗材费用比间比较,差异有统计学意义(P<0.05)。多元逐步回归分析结果显示,影响恶性肿瘤放化疗患者住院费用的因素主要是性别、就诊医院等级、一年内住院次数及住院天数;影响老年性白内障患者住院费用的因素主要是年龄、就诊医院等级、住院天数及医用耗材费用比;影响冠心病和糖尿病患者住院费用的因素主要是年龄、性别、住院天数及医用耗材费用比。结论不同病种慢性病患者住院费用的影响因素不完全相同,医用耗材费用比是影响部分病种慢性病患者住院费用的因素之一,建议针对不同病种制定不同的住院费用控制方式。

Objective The study aimed to investigate the factors that influence hospitalization expenses of chronic disease patients registered with basic medical insurance for urban workers, especially the influence of high value medical consumables expenses,so as to provide recommendations for effective control of expenses and reduction of patients＇ financial burden. Methods We collected data of 6 035 eligible patients who used high value medical consumables（ unit price ≥ 500yuan） in 2010. The data were obtained from the Medical Insurance Settlement Management Center of Nanjing,Jiangsu Province in October,2012,including information about age,gender,disease category,hospital level,times of hospitalization per year,time of admission and discharge,hospitalization expenses,high- value medical consumables expenses and so on. The proportions of medical consumables expenses were calculated, and multiple stepwise regression analysis was conducted to determine the factors that influence the hospitalization expenses of patients with different chronic diseases. Results For all patients,high value medical consumables expenses accounted for 19. 7%（ 36 537 530. 0 /185 441 167. 2） in overall hospitalization expenses. For cancer patients undergoing chemotherapy, patients with senile cataract, coronary heart disease and diabetes, the proportionswere 13. 1%（ 17 898 103. 0 /136 691 925. 3） 、 38. 6%（ 2 510 037. 0 /6 500 016. 5） 、 40. 9%（ 14 957 320. 0 /36 541 867. 0） and 20. 5%（ 1 172 070. 0 /5 707 358. 4） respectively,the difference between the proportions was statistically significant（ P〈 0. 05）. Multiple stepwise regression analysis indicated that,for cancer patients undergoing chemotherapy,the factors that influence hospitalization expenses were gender, hospital level, times of hospitalization per year, and length of hospitalized stay; for patients with senile cataract,the factors were age,hospital level,length of hospitalized stay and proportion of medical consumables expenses; for patients with coronary heart disease or diabetes,the factors were age,gender,length of hospitalized stay and proportion of medical consumables expenses. Conclusion The factors that influence hospitalization expenses vary with different chronic diseases,among which high value medical consumables expenses is an important factor. Different ways should be taken to control hospitalization expenses of patients with different chronic diseases.