基于结构变动度的医院远程医疗住院费用控制实证研究

Study on the Inpatient Expenditure of Hospital Telemedicine Service Based on Structure Variation Degree

目的:分析新疆克拉玛依市中心医院接受远程医疗服务患者住院费用的结构变化情况,为远程医疗价格标准的制定及费用控制提供依据。方法:收集该医院2014—2016年接受和未接受远程医疗服务住院患者费用明细,采用结构变动度法,分析该医院住院费用的结构变化情况。结果:接受远程医疗服务患者的住院次均费用明显高于未接受远程医疗服务患者的住院次均费用;接受远程医疗服务住院患者的次均费用结构变动度大于未接受远程医疗服务住院患者的次均费用结构变动度,且结构变动度均在增大。药品费、材料费、检查检验费和治疗费是对费用结构变动贡献较大的影响因素,且不同费用项目的结构贡献率不尽相同。结论:远程医疗虽然在一定程度上使得高水平的医疗服务得到下沉,但由于其费用较高,增加了住院患者的疾病负担。药品费用虽然呈下降趋势,但药占比仍然较高,仍需控制。材料费、检查检验费是远程医疗费用控制的重要环节。建议通过价格机制调整劳务费用结构,建立健全远程医疗全程管理制度,避免医疗资源浪费。

Objective： To analyze the inpatient expenditure thai accepted telemedicine service for the policy purpose of telemedicine service price adjustment and cost control, so as to provide evidence for the design and cost control of telemedicine service standard. Methods： Degree of structure variation（DSV） was used for the expenditure analysis with the data collection in the target hospital from 2014 to 2016. Results： Average patient expenditure accepted telemedicine were higher than that unaccepted, DSV of expenditure accepted telemedicine was also higher than that unaccepted. Expenditure medicine, materials, checkup and treatment were the factors for DSV, of which the contribute rates were also different from the different expenditures. Conclusion： Telemedicine made high tecb- nology fall down the rural place but increased the inpatient expenditure because of high expenditure. Though the drug expenditure showed decreasing trend, but the drug proportion was still high, which needed to be control. Material costs and examination expenditure were important links for telemedicine expense control. It was suggested to adjust the technique price of health workers, make up the full path management schemes and regulations in order to avoid medical resources waste.