徐州市三级综合医院2007-2013年肺癌患者住院费用分析

Analyses of hospitalization expenses of patients with lung cancer belonging to third grade general hospitals from 2007 to 2013 in Xuzhou

目的随着经济的快速发展、生活方式以及人口结构的变化,肺癌因其高发病率及高死亡率已成为影响人们生命健康的主要公共问题。本研究分析2007-2013年徐州地区三级综合医院肺癌患者的住院费用,为下一步肺癌防控及卫生决策提供参考依据。方法随机抽取徐州市3家三级综合医院,并摘录其2007-2013年收治的肺癌患者病例资料,采用我国医疗保健消费价格指数将费用数据贴现,再采用时间序列分析中的线性模型及年均增长率等方法估算次均住院费用、日均住院费用以及各自构成的趋势变化情况。结果 3家医院累计摘录肺癌患者病例资料17 235人次,最终获取有效病例资料15 868人次,有效率92.07%(15 868/17 235)。患者平均年龄为(63.30±11.31)岁。肺癌患者次均住院费用自2007年的14 587.93元上升至2013年的21 103.92元,年均增长率为6.35%(F=39.255,b1=1 292.681,P<0.05);费用构成中,以药品费用所占比重最高,范围在41.00%~52.00%,但构成比的上升速度以其他费用最快,年均增长率为27.51%;各项目费用中,以其他费用的增长速度最快,自2007年的621.36元上升到2013年的3 556.10元,年均增长率为33.10%(F=28.967,b1=541.334,P<0.05)。肺癌患者日均住院费用自2007年的778.05元上升至2013年的1 475.69元,年均增长率为11.26%(F=263.614,b1=118.149,P<0.05);各项费用中以其他费用的日均费用上升速度最快,年均增长率为31.07%(F=33.310,b1=16.164,P<0.05)。结论徐州市肺癌患者的次均住院费用呈日益上升趋势;药品费用仍占有最高构成比,且与蛋白质、化验和其他费用数值呈不同程度增长,但因其增长速度慢,在总费用的占比呈下降趋势;单纯通过减少住院天数并不能降低肺癌患者住院费用。

OBJECTIVE With the rapid economic development, demographic structure and lifestyle changes, lung cancer for its high incidence and high mortality rate have become a major public problem affecting people＇s life and health. In this study,three were randomly selected from seven Third Grade general hospitals in Xuzhou to analyze the expenses from medical records of all patients with lung cancer who met the requirements from 2007 to 2013 ,and to explore the hospitalization costs and to provide scientific data for developing prevention and intervention of lung cancer. METHODS Three were randomly selected from seven Third Grade general hospitals in Xuzhou by a random number table. The general characteristics of all the patients who were diagnosed as lung cancer and were discharged between 2007 and 2013, such as hospitalization and hospitalization costs,were obtained from the three hospitals through the hospital information system. Exclusion criteria including non-related treatment costs, non-lung cancer-related treatment, voluntary abandonment of treatment and other case data. All cost of data obtained were discounted uniformly by consumer price index（CPI） ,based on the year of 2013. Time series trend analysis was used to judge the trend of cost,and cost structure and hospitalization day in 7 years. Then average growth rate per annum （AAGR） was used to describe the rate of change of the cost. RESULTS Totally 17 235 lung cancer patients was selected in the 7 years,and the number of valid medical records was 15 868. The effective rate was 92. 07% （15 868/17 235）. The mean age of the patients was （63. 30±11.31） years old. The fee per hospital visit of lung cancer patients increased from 14 587.93 RMB in 2007 to 21 103.92 RMB in 2013 and AAGR was 6.35%（F=39. 255 ,b1=1 292. 681 ,P〈0. 05）. Drugs costs accounted for the highest proportion in the fee per hospital visit,ranging from 41.00% to 52.00%. The composition ratio of other expenses rose the fastest and AAGR was 27.51%. Other expenses rose the fastest and increased from 621.36 RMB in 2007 to 3 556. 10 RMB in 2013,and AAGR was 33.10% （F=28. 967,b1 =541. 334,P〈0.05）. The daily average cost of patients with lung cancer increased from 778.05 RMB in 2007 to 1 475.69 RMB in 2013 （P〈0.05） ,and AAGR was 11.26%（F=263. 614, b1 =118. 149,P〈0.05）. The daily average costs of other expenses rose the fastest and the AAGR was 31.07% （F=33. 310,b1 =16. 164,P〈0.05）. CONCLUSIONS The fee per hospital visit for lung cancer patients was on the rise in Xuzhou. Drug costs still occupied the highest proportion. Drug costs and protein costs,laboratory fees and other expenses showed varying degrees of growth. The downward trend in drug costs on the surface was mainly due to its slower growth. Simply reducing the number of days in hospital could not reduce the hospitalization expenses of patients with lung cancer.