心血管病专科医院住院患者医疗费用的影响因素

Influence factors of hospitalization expenses in a specialist hospital for cardiovascular disease

目的探讨影响心血管疾病患者住院医疗费用的主要因素，为合理分配医疗资源和控制医疗费用提供参考。方法收集山西省心血管病专科医院1928例住院患者的基本信息、医疗费用及相关因素，采用单因素和多重线性回归方法分析心血管疾病患者住院费用的影响因素。结果1928例患者中，男性（1094例）多于女性（834例），中位住院时间为9d（1~65d），中位年龄63岁（7～94岁），中位住院医疗费用为11554．32元。影响住院费用的单因素分析显示男性显著高于女性，急诊人院高于其他方式入院，住院20d及以上者显著高于不足20d者，手术者高于未手术者，危重者高于非危重者、有伴随病情者高于无伴随情况及不详者，治愈者高于无改善／死亡者，全公费／全自费／其他付费方式高于其他付费方式（P均〈0．01）。多重线性回归分析显示，影响心血管疾病住院患者医疗费用因素分别为性别、急诊人院、住院天数、有无手术、是否危重及全公费／全自费／其他付费方式，标准化回归系数分别为0．05、0．13、O．47、0．51、0．05、0．03。结论建议严格掌握手术适应征，缩短住院时间，并根据入院途径和疾病的严重程度选择合理的治疗方案以可降低心血管患者的住院费用，减轻患者和社会的经济负担。

Objective To explore the cost of hospitalization for cardiovascular disease and analyze the main influence factors, so as to provide reference for the rational allocation of medical resources and control of medical expenses. Methods The basic information, medical expenses and related factors of 1 928 inpatients in Shanxi Cardiovascular Disease Specialist Hospital were collected. The factors influencing hospitalization expenses of patients with cardiovascular disease were analyzed by single factor and multiple linear regression. Results Among 1 928 patients, there were more males （1 094 cases） than females （834 cases）. The median length of hospital stay was 9 days （range, 1-65 days）, the median age was 63 years （range 7-94 years）, and the median hospital medical expenses was 11 554.32 yuan. The single factor analysis on main factors that affected the cost of hospitalization for cardiovascular disease showed that males were more than females, emergency cases were more than other admission route, cases ≥20 days of hospital stay were more than 〈20 days, patients taken surgery were more than those taken no surgery, patients in severe condition were more than not, patients with concomitant disease were more than those without concomitant disease or not quite clear, patients cured were more than not improved or dead, and patients with public medical care or self-paying were more than other payments （P all〈0.01）. The analysis ofmultiple linear regression revealed that the effects influencing the hospital cost of patients with cardiovascular disease were gender, emergency visit, length of hospital stay, with or without surgery, severe case or not and public medical care/self-paying/other payment. The normalized regression coefficients were 0.05, 0.13, 0.47, 0.51, 0.05 and 0.03, respectively. Conclusions A strict control of surgical indications, a shorten of the hospital stay, and according to the admission route and the severity of the disease to choose a reasonable treatment program are suggested to reduce cardiovascular hospitalization costs and the economic burden of patients and society.