山东省老年医保患者住院费用及影响因素路径分析

Hospitalization cost and its determinants among elderly inpatients in Shandong province: a path analysis

目的了解山东省老年医保患者住院费用情况,探讨老年医保患者住院费用影响因素,为降低老年人疾病经济负担提供依据。方法基于第五次国家卫生服务调查山东省的部分数据,选取≥60岁的老年医保住院患者1 184例,利用SPSS 17.0软件包对老年医保患者住院费用进行统计描述、聚类分析和相关分析,用Amos 21.0软件包进行影响因素路径分析。结果山东省老年医保患者人均住院费用为10 993.78元,中位数为5 000元,人均住院天数为13.77 d;聚类分析结果显示,20.8%的老年患者住院费用偏高,50.9%的患者住院费用中等,28.3%的患者住院费用较低。路径分析结果显示,住院天数、医院级别、是否手术是影响住院费用的主要因素,路径系数分别为0.435、0.374、-0.271;医院级别、居住地、婚姻状况可通过影响住院天数间接影响住院费用,间接路径系数分别为0.035、0.035、0.028。结论多种因素共同作用影响住院费用,可探索多种方式减轻老年医保住院患者的费用。

Objective To investigate hospitalization cost and its related factors among elderly inpatients covered by medical insurance in Shandong province and to provide a basis to reduce the economic burden of the elderly inpatients.Methods Information on 1 184 elderly inpatients aged 60 years or above and covered by medical insurance were extracted from the dataset of Shandong province of Fifth National Health Service Survey conducted in 2013. SPSS 17. 0 was used in statistical description,cluster analysis,chi-square test,and correlation analysis. Amos 21. 0 was used to carry out path analysis. Results The average cost of per hospitalization for the elderly inpatients surveyed was 10 993. 78 yuan（ RMB）,with a median of 5 000 yuan and an average stay of 13. 77 days. Cluster analysis results showed that the proportions of the elderly inpatients with higher,medium,and lower hospitalization cost were 20. 8%,50. 9%,28. 3%,respectively. The results of path analysis showed that hospitalization days,the degree of the hospital,whether having an operation during the hospitalization were the main influencing factors of hospitalization expenses,with the path coefficients of0. 435,0. 374,and- 0. 271; the degree of the hospital,residential area and marital status of the inpatients were indirect influencing factors of hospitalization cost with the indirect path coefficients of 0. 035,0. 035,and 0. 028,respectively. Conclusion Many factors influence hospitalization cost and comprehensive measures should be taken to control the increase of hospitalization cost among elderly inpatients in Shandong province.