河南省疟疾患者医疗费用及其相关影响因素分析

Medical Costs on Malaria in Henan Province and Analysis of the Influential Factors

目的了解河南省疟疾患者诊治过程中的医疗费用情况,并探讨其影响因素。方法收集2013年11月-2014年10月河南省各级卫生机构诊断并网报的疟疾病例,对经镜检确诊的疟疾病例进行个案调查,收集病例的一般信息和诊治信息。运用SPSS17.0统计学软件,采用两(多)独立样本秩和检验及逐步回归分析法探讨疟疾患者医疗费用情况,及其相关影响因素。结果共调查了218例疟疾病例,其中73.4%来自乡村,其人均医疗费用为1 503元,来自城镇的患者人均医疗费用为4 833元;初诊选择乡村医院的患者人均医疗费用为2 600元,初诊选择省级综合医院的患者人均医疗费用为7 800元;在市、县级医院确诊患者的人均医疗费用为1 022.5元,在省级综合医院确诊患者的人均医疗费用为6 170元;经过1次就诊即确诊的患者人均医疗费用为0元(抗疟药免费),经过3次以上就诊确诊的患者人均医疗费用为5 621元。单因素分析结果显示,对医疗费用差异有统计学意义的变量为:疟疾患者的现居住地、初诊医院级别、确诊医院级别和就诊次数等因素(P<0.05)。逐步回归分析显示,初诊医院级别是疟疾患者医疗费用高低最主要的影响因素,其次为确诊医院级别、确诊前就诊次数。初诊医院、确诊医院级别越高,医疗费用越高,确诊前就诊次数越多,医疗费用越高。结论河南省疟疾患者的医疗费用与患者的就医行为存在着较明显的关联。

Objective To analyze the costs for the diagnosis and treatment of malaria in Henan Province and the influential factors. Methods Malaria cases diagnosed in and reported by medical institutions in Henan Province from November 2013 to October 2014 were selected. General information and clinical information of those with further microscopic confirmation were also collected. The rank sum test for two or more independent samples and stepwise regression analysis were used to investigate the influential factors for medical costs. Results A total of 218 malaria cases were finally included, of whom 73.4% were from rural areas. On average, the medical costs for patients from rural areas and cities/towns were 1 503 yuan and 4 833 yuan respectively. The average medical cost per patient with first-visit in rural hospitals was 2 600 yuan, and that with first-visit in provincial hospitals was7 800 yuan. The average medical costs for patients diagnosed in county/city-level hospitals and provincial hospitals were 1 022.5 yuan and 6 170 yuan, respectively. There was null cost for patients diagnosed at the first-visit, while for those diagnosed after 3 or more visits the average cost per patient was 5 621 yuan. Factors significantly associated with medical costs were the current living locality of patients, the hospital level of first-visit, the hospital level of diagnosis and the number of visits before diagnosis（P〈0.05）. Stepwise regression analysis showed that the hospital level of first-visit was the most important influential factor for medical cost, followed by the hospital level of diagnosis and the number of visits before diagnosis. The higher hospital levels of first-visit and diagnosis, the higher cost. The same applied to the number of visits before diagnosis. Conclusion There is an considerable correlation between medical cost and health seeking behavior in malaria patients.