乙型肝炎患者住院费用与医疗保险支付的典型相关分析

Canonical Correlation Analysis on Hospital Costs and Medical Insurance Payment of Hepatitis B Patients

目的探讨乙型肝炎(乙肝)患者住院费用和医疗保险(医保)支付的内部构成情况,为乙肝医保制度的制定和完善提供参考。方法运用典型相关分析法,分析2014年7月—2015年4月在江苏省南京市某三级医院感染科住院的115例乙肝患者的住院费用及医保支付情况。结果乙肝患者住院费用中药费所占比例最高,为91.0%(1 187 316.0/1 304 070.0);其次为检查检验费(5.7%,74 764.7/1 304 070.0)。乙肝住院费用的医保支付中统筹支付所占比例最高,为62.5%(815 127.1/1 304 070.0);其次为个人自付(31.2%,406 508.5/1 304 070.0)。乙肝患者住院费用和医保支付综合变量之间的典型相关系数为0.968,说明两者关系为高度相关。住院费用综合变量中药费的载荷系数的绝对值最大,为0.825;医保支付综合变量中统筹支付的载荷系数的绝对值最大,为1.012。结论乙肝患者住院费用结构不合理,药费和检查检验费所占比例较大,乙肝住院患者个人负担仍然较重,建议改变后付制的医保费用支付方式,借鉴西方国家采用预付制的住院费用支付方式。

Objective To analyze the internal composition of hospitalized fee and medical insurance payment of hepatitis B（ HBV） patients and provide a reference for formulating and perfecting medical insurance system for HBV. Methods The hospitalized fee and medical insurance payment of 115 HBV patients in the infections department of a tertiary hospital in Nanjing,Jiangsu Province from July 2014 to April 2015 were analyzed by canonical correlation analysis. Results The proportion of medicine fee in hospitalized fee of HBV patients was the highest（91. 0%,1 187 316. 0 /1 304 070. 0） and the inspection fee was the secondly highest（ 5. 7%,74 764. 7 /1 304 070. 0）. The proportion of payment by social pooling account of medical insurance fund payment in hospitalized fee of HBV patients was the highest（62. 5%,815 127. 1 /1 304 070. 0） and self pay was the secondly highest（31. 2%,406 508. 5 /1 304 070. 0）. The canonical correlation coefficient between the comprehensive variables of hospitalized fee and those of medical insurance payment of HBV patients was 0. 968, which showed high correlation. The absolute value of loading coefficient about medicine fee among the comprehensive variables of hospitalized fee was the highest（0. 825）. The absolute value of loading coefficient of payment by social pooling account among the comprehensive variables of medical insurance payment was the highest（1. 012）. Conclusion The hospitalized fee structure of HBV patients is unreasonable,for the proportion of medicine expenses and inspection fee is too large and the individual burden of hospitalized patients with HBV is still very heavy. The post payment system of medical insurance payment should be changed, and the prospective payment system as hospitalization fee payment mode used by western countries should be used as a reference.