骨科医保住院患者医院感染经济与社会效益损失对比研究

Comparative study of economic and social benefit loss of hospitalized patients with medical insurance in department of orthopedics due to nosocomial infections

目的探讨骨科医保住院患者医院感染造成的经济损失,为医院管理部门和医疗保险部门合理制定医院感染管理相关政策提供科学依据。方法选取2013年1月-2015年5月骨科医保住院患者5 558例,将发生医院感染患者为感染组,同期未发生感染的患者为对照组,两组患者分别按条件1∶1配比,农村合作医疗保险患者配对成功96对,城镇职工医疗保险患者配对成功65对,共计161对,统计分析两组两类医保患者主要经济指标和社会效益指标的差异。结果医院感染组与对照组患者的平均住院费用、农村合作医疗保险患者、城镇职工医疗保险患者平均住院费用分别为47 796.06元、22 269.93元,48 340.52元、22 494.52元,46 991.93元、21 938.19元;医院感染组平均每例患者多支出25 526.13元,是对照组的2.15倍,平均每例农村合作医疗保险和城镇职工医疗保险患者分别多支出25 526.13元、25 053.74元,两组间两类患者及其总费用差异均有统计学意义(P<0.01)。结论要加强医院感染管理,加大对医院感染的投入,给予政策支持,形成医保、医院、科室与患者共同承担且合理的医院感染管理成本分担机制。

OBJECTIVE To explore the economic loss of the hospitalized patients with medical insurance in department of orthopedics due to nosocomial infections so as to provide scientific basis for development of reasonable management policies in hospital administration departments and medical insurance departments.METHODS A total of 5 558 patients with medical insurance who were hospitalized the department of orthopedics from Jan 2013 to May 2015 were enrolled in the study and divided into the infection group and the control group.In a conditional 1：1ratio,totally 96 pairs of patients with rural cooperative medical insurance were paired successfully,and 65 pairs of patients with urban workers medical insurance were successfully paired,161 pairs in total.The differences in the major economic indicators and social benefit indicators were statistically analyzed between the two groups of patients with two types of medical insurance.RESULTS The average hospitalization cost of the infection group was47 796.06 yuan,the control group 22 269.93;the average hospitalization cost of the patients with rural cooperative medical insurance was 48 340.52 yuan in the infection group,22 494.52 yuan in the control group;the average hospitalization cost of the patients with urban workers medical insurance was 46 991.93 yuan in the infection group,21 938.19 yuan in the control group;the average expense of each case of the infection group was 25 526.13 yuan more than that of the control group,2.15 times the control group;the average expense of each patient with rural cooperative medical insurance was 25 526.13 yuan more in the infection group than in the control group,and the average expense of each patient with urban workers medical insurance was 25 053.74 yuan more in the infection control than in the control group,there was statistically significant difference in the total cost between the two types of patients of the two groups（P〈0.01）.CONCLUSION It is necessary to strengthen the control of nosocomial infections,increase the invest on the control of nosocomial infections,give policy support,and develop a reasonable hospital infection management cost sharing system among the medical insurance,hospitals,departments,and patients.