基于经常性卫生费用的辽宁省治疗费用负担性别分布分析

Sex-specific Analysis of the Burden of Cost of Treatment in Liaoning Province in 2014 Based on Current Health Expenditure

目的运用"卫生费用核算体系2011"(SHA2011)核算辽宁省经常性卫生费用,在此基础上,从性别差异角度对治疗费用的人群分布状况进行分析,为辽宁省政府卫生部门制定相关卫生政策提供更加准确的卫生经济信息。方法采用多阶段分层随机抽样,抽取辽宁省大连市、辽阳市、盘锦市及铁岭市作为样本地区,随机抽取综合医院、中医院、专科医院、基层医疗卫生机构、门诊机构、公共卫生机构。综合医院抽取2014年1月、4月、7月、10月数据,其他医疗机构提取2014年全年数据。由医疗机构信息科提供门诊和住院的所有患者性别、年龄、疾病等资料。由卫生财务年报和卫生统计年鉴以及各地区卫生计生委提供的数据计算治疗费用。分析不同性别人群和各种疾病所消耗的治疗费用。结果综合医院、中医院、基层医疗卫生机构、门诊机构男性和女性治疗费用约各占50.00%。专科医院男性治疗费用约为女性治疗费用的2倍。公共卫生机构治疗费用构成基本为女性患者,占92.66%。医院治疗费用为6 578 702.49万元(85.18%),医院中以综合医院为主,治疗费用为5 543 941.47万元(71.78%)。男性患者人均治疗费用为1 725.76元,女性患者人均治疗费用为1 914.63元。男性治疗费用主要发生在55~64岁,女性治疗费用主要发生在25~29岁。根据国际疾病分类第10版(ICD-10),女性治疗费用主要发生在循环系统疾病(20.88%),妊娠、分娩和产褥期(14.67%),呼吸系统疾病(9.68%)。男性治疗费用主要发生在循环系统疾病(37.63%),消化系统疾病(13.30%),呼吸系统疾病(7.57%)。根据全球疾病经济负担分类法(GBD),男性和女性治疗费用均主要发生在非传染性疾病,分别占71.23%和56.57%。结论辽宁省女性比男性医疗负担重;不同性别在不同年龄段医疗负担有所区别;慢性非传染性疾病治疗费用所占比例较高,需要重点控制。

Objective To account the current health expenditure in Liaoning Province by using System of Health Accounts 2011 （SHA2011） , and based on this, to present the sex - specific differences in burden of cost of treatment in the province, so as to provide more accurate heahhcare economic information for policy - making by the health administrators from The People＇s Government of Liaoning Province. Methods By using multistage sampling and stratified sampling, Dalian, Liaoyang, Panjin and Tieling were chosen as the sample areas, and from which, a range of general hospitals, TCM hospitals, specialized hospitals, grassroots medical institutions, clinics, and public health institutions consisted of maternity and child care institutions mainly were selected. Relevant data from general hospitals in January, April, July and October of 2014 and from other medical institutions in 2014 were extracted. From the information department of these institutions, we obtained the outpatients and inpatients＇ data such as sex, age and diagnosis and so on. Based on the data from annual health finance reports, health statistics yearbook, and health and family planning commissions of various districts of the sample areas, we calculated and analyzed the cost of treatment of the participants, cost of treatment by sex and by the type of disease in these institutions. Results In general hospitals, TCM hospitals, grassroots medical institutions and clinics, female patients had the same cost of treatment as male patients; in specialized hospitals, the cost of treatment of male patients almost doubled that of female patients ; in public health institutions, the cost of treatment of female patients made up 92.66% of the total cost of treatment of the participants from these institutions. The cost of treatment of the participants from general hospitals, TCM hospitals and specialized hospitals totaled 65 787. 024 9 billion, and that of the participants from general hospitals were 55 439. 414 7 billion, respectively accounting for 85.18%, 71.78% of the total cost of treatment of participants from all the selected institutions. The cost of treatment per capita for male and female participants were 1 725.76 yuan and 1 914. 63 yuan respectively. Expenses spent by males aged 55 - 64 occupied the majority of cost of treatment for males, and those by females aged 25 - 29 accounted for the majority of cost of treatment for females. If classified by the International Classification of Diseases 10th Revision （ ICD - 10）, the major diseases that females paid for treatment were circulatory system diseases （ 20. 88% ） , disorders during pregnancy and puerperium and childbirth - associated diseases （ 14. 67% ） and respiratory diseases （ 9. 68% ） , and those that males paid for treatment were circulatory system diseases （37.63%）, digestive diseases （ 13.30% ） and respiratory diseases （7.57%） ; if classified by the global burden of disease （GBD） , the major diseases that both males and females paid for treatment were non - communicable diseases, respectively accounting for 71.23%, 56. 57% of the total cost of treatment of male participants, and that of female participants. Conclusion The medical burden on females was much heavier than that on males in Liaoning Province. The burdens for males and females were different in terms of age. Non - communicable diseases accounted for the most part of cost of treatment, which needs to be paid attention.