某大型三甲医院住院疾病直接医疗费用及费用构成研究

Study on the Direct Medical Expenses and Cost Composition of Inpatient Diseases in a Large Tertiary A hospital

目的通过分析某大型三甲医院住院患者直接医疗费用,了解住院费用较高的疾病并分析其费用构成,为相关政策及措施提供参考。方法调取某大型三甲医院2017年4月20日-2018年4月30日所有出院患者病案,除外排除和异常数据后,共计169729例。按病种分类,统计住院费用、住院人次、死因顺位、医保支付情况、费用构成等资料并进行数据分析。结果住院总费用较高的前十种疾病依次为不稳定性心绞痛、原发性肝细胞癌、肺上叶恶性肿瘤、直肠恶性肿瘤、肺下叶恶性肿瘤、腰椎间盘突出、胰头恶性肿瘤、肾恶性肿瘤、股骨头缺血性坏死、单膝关节病(炎)。其中,股骨头缺血性坏死、胰头恶性肿瘤、单膝关节病(炎)是医保患者中经济负担相对较重的3种疾病,不稳定性心绞痛、肺上叶恶性肿瘤及腰椎间盘突出是医保统筹支付压力较大的3种疾病。费用构成分析显示住院总费用较高的疾病中,不稳定性心绞痛治疗费占该疾病住院总费用的61.50%,恶性肿瘤药费占该类疾病住院总费用的21.12%至48.46%,骨关节疾病手术费占该类疾病住院总费用的37.16%至77.88%。结论应加强不稳定性心绞痛介入治疗方案的综合评价,规范相应检查。强化恶性肿瘤疾病的诊疗路径研究及基于诊疗路径的经济性评价,强化该类疾病的诊疗创新及药物创新。加强骨关节疾病手术耗材的经济性评价及术后感染监测。在保证医疗质量的同时,使医疗费用得到有效控制。

Objective By analyzing the direct medical expenses of inpatients in a hospital,identify the diseases with higher hospitalization costs and analyze their cost composition,so as to provide references for relevant policies and measures.Methods The medical records of all discharged patients were collected from a large third-grade class-A hospital covering the whole countryon April 20,2017,solstice,April 30,2018.The patients were classified by disease type.The data of inpatient expense,inpatientnumber,rank order of causes of death,medical insurance payment,cost composition and so on were counted and analyzed.Results The top 10 diseases with higher total hospitalization costs were Unstable angina pectoris,Primary hepatocellular carcinoma,Malignant tumors in the upper lobe of the lung,Rectal Malignant tumors,Malignancy in the lower lobe of the lung,Lumbar disc herniation,Pancreatic head Malignant tumors,Renal malignant tumors,Avascular necrosis of the femoral head,Single knee joint disease(inflammation).Among them,Avascular necrosis of the femoral head,Pancreatic head Malignant tumors and Single knee joint disease(inflammation) are the three diseases with relatively heavy economic burden among medicarepatients,while Unstable angina pectoris,Malignant tumors in the upper lobe of the lung and Lumbar disc herniation are the three diseases with high pressure of overall medical insurance payment.The analysis of cost composition shows that for diseases with higher total hospital costs,unstable angina pectoris accounts for more of the disease in the hospital total cost(61.50%),malignant tumor drug costs account for more of this kind of disease in the hospital total cost(21.12% to 48.46%),and osteoarthrosis surgery of larger(of this kind of disease in the hospital total cost accounting for 37.16% to 77.88%).Conclusion Unstable angina pectoris,malignant tumor and osteoarthrosis are the three major diseases with high direct medical expenses,and consume a large amount of medical insurance pooling fund.The comprehensive evaluation of interventional therapy for unstable angina pectoris should be strengthened and the corresponding examination should be standardized.Strengthen the research of diagnosis and treatment path of malignant tumor diseases and strengthen the diagnosis and treatment innovation and drug innovation based on the economic evaluation of diagnosis and treatment path.Economic evaluation and postoperative infection monitoring of surgical consumables for should be strengthened. While ensuring the quality of medical care,medical expenses are effectively controlled.