四川省三级医院慢性阻塞性肺疾病患者参加医疗保险类型与其住院时间的关系——基于分位数回归模型的实证分析

The relationship between the types of medical insurance and the length of stay of COPD patients in tertiary hospitals of Sichuan province:An empirical analysis based on quantile regression model

目的:分析慢性阻塞性肺疾病(COPD)患者参加医疗保险类型与其住院时间的关系,对患者平均住院日的降低和医疗保险支付方式的完善提供参考。方法:利用2016年第四季度在四川省三级医院就诊的36329例COPD患者病案首页信息,采用分位数回归模型,分析患者不同参保方式与其住院天数的关系。结果:不同参保方式患者的住院时间存在统计学差异,且这种差异大部分是由参保方式不同造成的。全公费患者住院天数最长,新型农村合作医疗参保患者最短,这种差异随住院时间分位数的提高而变大。结论:不同参保方式的COPD患者住院时间存在差异。全公费和城镇职工医疗保险参保患者的住院天数相对更长的可能原因是医院过度提供医疗服务;新型农村合作医疗参保患者的住院时间最短,可能原因是医院将其住院床位转移给了全公费和城镇职工医疗保险患者;不同医疗保险主办方监管力度不同也可能是造成差异的原因。

Objective:The goal of this study is to analyze the relationship betweenthe types of medical insurance chosen by patients with chronic obstructive pulmonary disease (COPD)and their length of stay in hospitals(LOS), and thus to provide policy advice for improving medical insurance payment methods and reducing the average length of stay in hospitals (ALOS). Methods:Information on the first page of medical records of 36,329 patients with COPD in tertiary hospitals of Sichuan Province in the fourth quarter of 2016 are collected, and the quantile regression model is used to analyze the correlation between different types of medical insurance and length of stay. Results:There is a statistically significant difference in the length of stay between patients with different types of medical insurance, and most of this difference is caused by the difference in insurance types. Patients with free medical care have the longest LOS while patients withthe new rural cooperative medical scheme (NRCMS)have the lowest, and the difference increases with the quantile.Conclusions: There are differences in the length of stay between different types of medical insurance. The reason for the relatively longer LOS for patients with free medical care and urban employee basic medical scheme (UEBMS)is that hospitals provide excessive medical services. On the other hand, the NRCMS patients have the shortest LOS possible because hospitals may transfer their inpatient beds to free medical care and UEBMS patients. At the same time, the supervision of different medical insurance sponsors may also be the cause of the difference.