2015年山西省布鲁氏菌病患者的直接医疗费用及构成分析

Analysis on direct medical expenditure and its constituent of brucellosis patients in Shanxi

目的对山西省市(县)级布鲁氏菌病(布病)患者的直接医疗费用进行分析,评估患者的医疗负担,为制定布病防控策略和优化卫生资源配置提供参考依据。方法回顾性收集2015年山西省2个布病重点地级市医疗机构诊治布病患者的直接医疗费用,建立数据库,进行描述性分析。结果 842例患者直接医疗费用中位数为3 276.12元;其中344例门诊患者为216.98元,498例住院患者为5 678.06元。患者间医疗费用均存在较大差异,但就诊于市级医疗机构的患者费用高于县级医疗机构。对其中466例住院患者费用构成情况进一步分析发现,医疗费用以药物费和化验费为主(70.45%),但7例行手术治疗的患者医疗费用明显高于未行手术患者(Ζ=-2.948,P=0.003),医疗费用主要为药物费(40.62%)、卫生材料费(29.19%)和化验费(9.43%);而未行手术的患者医疗费用则以药物费和化验费为主,占71.32%。急性期和慢性期患者医疗费用差异无统计学意义(Ζ=-1.249,P=0.212)。结论布病患者的直接医疗费用负担较重。建议当地医疗机构应参照《布鲁氏菌病诊疗指南》科学规范开展诊疗工作;疾病预防控制部门加强对农牧民等重点人群的宣教,提高个人防护和早期就诊意识,减少并发症,降低疾病给国家和个人带来的经济负担。

ObjectiveTo understand the medical cost burden of brucellosis patients in Shanxi province and provide evidencefor the development of brucellosis prevention and control strategies and the optimization of health resource allocation.MethodsThe direct medical expenditure information of brucellosis patients were collected retrospectively from 5 medicalinstitutions in 2 areas with serve brucellosis epidemic in Shanxi in 2015,and a database was established for the data analysis.ResultsAmong 842 patients surveyed,the median of direct medical expenditure was 3 276.12 yuan（RMB）,and it was216.98 yuan（RMB）in 344 outpatients and 5 678.06 yuan（RMB）in 498 inpatients. The medical expenditure was significantlydifferent among the patients. The median of medical expenditure of patients of city-level medical institutions was higher than thatof patients of county-level medical institutions. Further analysis in 466 inpatients indicated that the medical expenditure mainlyconsisted of drug fee and laboratory test fee（70.45%）,Seven patients who underwent surgeries had higher medical expenditurecompared with the patients who underwent no surgeries（Ζ =-2.948,P=0.003）,and their medical expenditure mainlyincluded drug fee（40.62%）,medical material fee（29.19%）and laboratory test fee（9.43%）,while the medical expenditure ofthe patients without surgeries was mainly composed of drug fee and laboratory test fee（71.32%）. There was no difference inmedical expenditure between acute patients and chronic patients（Ζ=-1.249,P=0.212）.ConclusionThe economic burdenof brucellosis patients was heavy. It is suggested to conduct standardized medical service according to the guideline of brucellosisdiagnosis and treatment（2012 version） and strengthen the health education in population at risk,such as farmers andherdsmen,about self-protection,the importance of early medical seeking and how to reduce complications to lighten theeconomic burden for both society and individuals.