直肠肿瘤手术患者费用负担影响因素的树分析

Tree Analysis of the Influencing Factors for the Surgical Burden on Rectal Cancer Patients

目的:分析直肠恶性肿瘤手术患者的住院费用负担情况,探讨其影响因素和分组路径,为医疗机构费用管理作借鉴,为减轻患者负担作参考。方法:回顾搜集2014年1月—2015年12月直肠肿瘤住院手术患者数据,应用树模型来推断住院费用负担的相关影响因素。结果:根治手术、超声刀与高频电刀的使用与住院费用可能存在统计学关联,造瘘手术与否、DRGs分组是患者住院费用及基金申报的主要判别因素。结论:医保待遇差异影响患者负担水平,手术术式及DRGs分组影响病种疾病负担,一方面政府应充分发挥医保的引导和杠杆作用,另一方面医疗机构宜细化病种费用管理、强化病种成本核算,共同推动肿瘤专业的三医联动。

Objective： To systematically analyze the hospitalization expenses and fund reimbursements for surgical rectal cancer patients, discuss the influence factors and grouping path, so as to provide cost management strategies for hospitals and make references for reducing the economic burden of patients. Methods： It retrospectively collected data of hospitalized patients from January 2014 to December 2015. Tree model was applied to construct pivotal influencing factors of hospitalization expenses and fund reimbursements. Results： Radical surgery, the use of ultrasonic knife and high frequency electric knife had statistical differences with hospitalization expenses; the operation of the fistula or not, Diagnosis Related Groups（DRGs） grouping was the main criteria for the patient＇s hospitalization expenses and fund reimbursements. Conclusion： Differences of the medical insurance affected the burden level of patients; surgical operation and DRGs grouping affected the burden of diseases. The government should give full play on the leverage role of medical insurance, meanwhile, the medical institutions should refine the cost management strategies, strengthen the cost accounting of diseases, and eventually to promote tripartite system reform jointly.