广州市某医院日间手术患者单病种费用及患者负担研究

Study on the Cost of Single Disease and Patient Burden of Ambulatory Surgery in Guangzhou City

目的:分析实施日间手术治疗患者费用情况,探索日间手术模式下单病种费用控制情况,为日间手术的推广提供科学参考依据。方法:以2018年广州市某医院开展日间手术治疗最多的3个单病种(取除输尿管支架、乳腺良性肿瘤、包皮过长)作为研究对象,以同期对应病种非日间手术治疗模式作为对照组,对2组手术患者的费用结构、平均住院日、平均床日费用、费用影响因素等进行对比分析。结果:取除输尿管支架、乳腺良性肿瘤、包皮过长3类病种日间手术组与非日间手术组次均总费用差异均有统计学意义(P<0.01)。按单病种付费制度下,实施单病种日间手术治疗能有效降低住院费用、缩短平均住院日。医保支付制度是影响日间手术费用最主要的因素,受其限制,实施日间手术治疗患者费用负担并未下降。结论:应优化病种费用结构,扩大按单病种支付患者范围,细化支付方式,以推进日间手术发展。

Objective:To explore the cost control of single disease under the mode of ambulatory surgery by analyzing the cost of ambulatory surgery,to provide scientific reference for the promotion of ambulatory surgery.Methods:In a hospital in Guangzhou,three single diseases(removal of ureteral stents,benign breast tumors and excessive prepuce)which were the most frequently treated by ambulatory surgery during 2018 were taken as the research objects,and the corresponding non-ambulatory surgical treatment mode was taken as the control group.The cost structure,average hospitalization day,average bed day cost and cost influencing factors of the two groups were compared and analyzed.Results:Under the single-disease payment system,the implementation of single-disease ambulatory surgery can effectively reduce hospitalization costs and shorten the average length of stay.Payment method was the most important factor affecting the cost of ambulatory surgery,but the cost burden of patients who were limited by payment method had not decreased.Conclusion:It is necessary to optimize the cost structure of disease types,expand the scope of patients who enjoy paying for a single disease type,and refine the payment methods to promote the development of ambulatory surgery.