北京市本地与外地肺癌患者就诊及医疗费用分析

Comparative Analysis on the Clinic and Medical Situations of Local and Provincial Patients with Lung Cancer in Beijing

目的分析北京市本地与外地肺癌患者的就诊行为、直接医疗费用和直接非医疗费用,为将来开展更大范围的筛查和早诊早治卫生决策提供依据。方法运用描述性统计分析对北京市本地与外地肺癌患者的诊疗情况和费用等进行归纳,采用卡方检验方法比较本地与外地肺癌患者病例分布差异,采用Wilcoxon秩和检验方法比较本地和外地肺癌患者的直接医疗费用与直接非医疗费用差异。结果北京市本地肺癌患者以65岁及65岁以上年龄组最多,占比约为57%,外地患者以55岁~64岁年龄组最多,占比约为36%;本地患者在综合医院的服务利用较多(约占56%),外地患者在专科医院的服务利用较多(约占87%);本地(约70%)和外地患者(约66%)均集中在临床分期的Ⅲ期和Ⅳ期,但外地患者Ⅱ期和Ⅲ期的比例均高于本地的;本地和外地患者均是单纯化疗的病例分布最多,占比分别为55%和56%;本地和外地患者的不同年龄组、不同类型医院、不同临床分期、不同治疗方式病例分布差异均有统计学意义(P≤0.001);本地和外地患者的次均直接医疗费用分别为25 329元、29 249元,次均直接非医疗费用分别为1326元、5867元。结论在京就诊的外地肺癌患者经济负担较本地患者重;与北京市本地肺癌患者相比,外地肺癌患者的诊疗需求多由肿瘤专科医院承担;外地中晚期和中年肺癌患者的跨区域医疗现象比较突出,且倾向于使用技术性较高的治疗手段。建议构建区域专科医疗中心来满足一个区域内居民的疑难危重病症的诊断与治疗。

Objectives To analyze the clinic situations,direct medical costs and direct non-medical costs of local and provincial patients with lung cancer in Beijing,and provide reference for a larger scale cancer screening as well as the health decision making of early diagnosis and treatment.Methods Descriptive statistics analysis was carried out on discovery approach and medical costs of local and provincial lung cancer patients in Beijing.Chi Square Test was carried out on differences in case distribution between local and provincial lung cancer patients in Beijing.Wilcoxon Rank Test was carried out on differences in direct medical costs and direct non-medical costs between local and provincial lung cancer patients in Beijing.Results Local lung cancer patients over 65 years old accounted for the most（57%）,and provincial patients of 55 to 64 years old accounted for the most（36%）.Local patients in general hospital were the most（56%）,and provincial patients in specialized hospital were the most（87%）.Local（70%） and provincial（66%） patients were in Ⅲ and Ⅳ,but provincial patients in Ⅱ and Ⅲ were more than local patients.Case distribution of chemotherapy in local（55%） and provincial（56%） patients was the most.There was a remarkable difference（P≤0.001） in Case distribution of age,hospital type,clinical stage,therapy between local patients and provincial patients.Average direct medical costs of local patients and provincial patients were 25329,29249 respectively,and average direct non-medical costs of local patients and provincial patients were 1326,5867 respectively.Conclusions The economic burden of provincial lung cancer patients is higher than local patients,and the specialized hospitals of cancer took on more provincial lung cancer patients than general hospitals.The cross-regional needs of provincial middle-aged patients and provincial patients with advanced lung cancer were obvious,and tended to apply treatment measures with high technology.It was suggested that to establish a regional specialized medical centers to fulfill the diagnosis and treatment on the difficulty and critical diseases of the residents in the area.