天津市某三级甲等医院2015年~2018年住院费用结构变动分析

Analysis on the structure changes of hospitalization expenses in a grade A tertiary hospital in Tianjin from 2015 to 2018

目的分析2015年~2018年天津市某三级甲等医院住院费用的构成变化情况,找出目前影响住院患者医疗费用的主要项目,为今后医院制定针对性措施控制医疗费用的不合理增长提供科学的参考依据。方法数据资料来源于天津市某三级甲等医院2015年1月1日至2018年12月31日HIS系统住院病案首页信息,从结构变动值、结构变动度和结构变动贡献率3个方面分析2015年~2018年住院费用的变化情况。结果2015年~2018年药品费和化验费占比一直位居各项费用前两位;除药品费、材料费和血费外,2018年其余各项费用占比均较2015年呈现不同程度的上升。2015年~2018年住院费用的总体结构变动度为18.94%,年均结构变动度为6.31%,引起住院总费用结构变动较大的因素主要为药品和化验,对住院费用结构变动贡献率最大的前5位项目依次为药品费、化验费、护理费、治疗费和检查费,5项累计贡献率为86.80%。结论药品费和化验费是目前影响住院费用的主要因素,药品费控制初见成效,但是医疗费用结构仍需优化。

Objective To analyze the changes in the composition of hospitalization expenses in a grade A tertiary hospital in Tianjin from 2015 to 2018,and identify the main items affecting the medical expenses of inpatients,so as to provide a scientific reference for hospitals to formulate targeted measures to control the unreasonable growth of medical expenses.Methods Data were collected from the front page of the medical records of a grade A tertiary hospital in Tianjin from January 1,2015 to December 31,2018.The data were analyzed in the aspects of the structure variation value,structure variation degree and contribution rate of structure variation.Results From 2015 to 2018,the proportion of drug and laboratory expenditure ranked the top two of all expenses.Except for expenditure of drug,material and blood,the proportion of other expenses in 2018 all increased compared with that in 2015.The sumup structure change of hospitalization expenses was 18.94%and the average annual structure change was 6.31%in 2015-2018.Drugs and laboratory tests were the main factors causing the change of total hospitalization expenses structure.The top five items contributing the most to the change of hospitalization expenses structure were drug,laboratory,nursing,treatment and examination.The cumulative contribution rate of the above five items was 86.80%.Conclusion Drug and laboratory expenditures are the main factors affecting hospitalization costs.Initial results have been achieved in the control of drug expenditure,but the structure of medical expenses still needs to be optimized.