1282例高额住院患者次均费用影响因素分析

Research on 1 282 cases of per-hospitalization high inpatient expenditure： influencing factors

目的分析某三级甲等医院2015年高额住院病例次均住院费用情况，并探究影响因素。方法采用回顾性分析方法，对某医院2015年住院费用超过10万元的1282例患者，采用方差分析和多元逐步回归分析法，对其费用影响因素进行统计分析。结果1282例高额住院患者平均住院天数为27．6天，人均住院费用149153元；住院费用构成中，药品费用和耗材费用所占比例较大，分别占总体费用的33．38％和31．98％；影响住院费用的主要因素依次为：住院天数、转归情况、并发症及院内感染、是否手术、患者性别等。结论降低平均住院日，控制药品及耗材费用，加强手术管理，控制过度医疗服务，是降低医疗费用过快增长的重要方法。

Objective To explore the causes of per-hospitalization high inpatient expenditure of a tertiary hospital in 2015,by analyzing the influencing factors. Methods We retrospectively studied 1 282 inpatient cases who cost more than 100 000 yuan per case at a tertiary hospital in 2015, analyzing statistically major influencing factors of such expenditure in variance analysis and multiple stepwise regression analysis. Results The average days of stay of these cases were 27.6 days, and the average medical cost of those cases was 149 153 yuan per person. Costs for medicines and material made up a large proportion of medical costs, respectively accounting for 33.38% and 31.98% of the total. The days of stay, prognosis of the patient, complications as well as hospital infection, surgeries, gender of the patients constituted major factors on inpatient medical expenditure. Conclusions Reducing the average days of stay, guiding reasonable applications of drugs and medical materials, strengthening management on operations and controlling excessive medical services are effective approaches to reducing excessive growth of medical costs.