浙江省肿瘤医院7387例肺癌手术患者住院费用及影响因素研究

A Study on Hospitalization Expenses and Influencing Factors of 7387 Lung Cancer Patients in Zhejiang Cancer Hospital

[目的]分析肺癌患者住院费用构成及影响因素,了解住院费用的动态变化,为优化医疗卫生改革方向和减轻肺癌患者经济负担提供数据支撑。[方法]从浙江省肿瘤医院电子病历系统中提取2015年1月1日至2019年12月31日肺癌住院患者的基本人口学信息、医保情况及住院费用等信息,采用SPSS19.0统计软件进行住院费用趋势分析,并采用单因素分析和多元线性回归分析探讨住院费用的影响因素。[结果]本文通过对浙江省肿瘤医院7387例肺癌病例进行分析,平均住院费用为4.9万元,材料费、西药费、化验费和手术费占比最高。对患者住院总费用的多因素分析结果显示,影响肺癌患者住院总费用的主要因素为住院天数、手术个数、是否腔镜手术、手术切除方式、入院年份、年龄、合并症数、住院次数、性别。多元线性回归方程为:Y=2004270.102+1212.330X1+2290.948X2+6027.970X3+1488.290X4-990.775X5+79.196X6+643.328X7-305.665X8-609.621X9。[结论]建议医保相关部门在制定肺癌手术DRG分组标准时考虑人口学和具体病理等相关因素,提高DRG分组器的分组质量,更好地实现DRG支付方式控费。同时多措并举进一步降低肺癌患者住院期间的各项费用,切实减轻肺癌患者的医疗负担。

[Purpose]To analyze the composition and influencing factors of hospitalization expenses for lung cancer patients and understand the dynamic changes of hospitalization expenses.Trying to provide theoretical and data support for optimizing the direction of medical and health reform and reduce the economic burden of lung cancer patients.[Methods]Basic demographic information,medical insurance status and hospitalization expenses of lung cancer inpatients were extracted from the electronic medical record system of Zhejiang Cancer Hospital,and statistical analysis was conducted using SPSS19.0 statistical software.The main statistical methods included the trend analysis of hospitalization expenses,and the influence factors of hospitalization expenses were analyzed by the univariable analysis and multivariable linear regression analysis.[Results]This article analyzed 7387 cases of lung cancer in Zhejiang Cancer Hospital.The average hospitalization expenses were 49000 yuan,which mainly included the cost of materials,western medicine,laboratory expense and surgery costs.With the passage of time,the average cost of hospitalization per capita decreased from 2014 to 2019,and the average cost per capita of hospitalization decreased significantly from 2018,with a decrease of 20.0%in 2019 compared with 2014.The results of multivariate analysis on the total hospitalization expenses of patients showed that the main factors influencing the total hospitalization expenses of patients with lung cancer were hospitalization length,number of surgeries,whether to perform laparoscopic surgery,surgical resection method,year of admission,age,number of complications,hospitalization frequency,and gender.The multiple linear regression equation is:Y=2004270.102+1212.330X1+2290.948X2+6027.970X3+1488.290X4-990.775X5+79.196X6+643.328X7-305.665X8-609.621X9.[Conclusion]It is recommended that the relevant departments consider demographic and specific pathological factors when formulating the DRG grouping criteria for lung cancer surgery and improve the grouping quality of the DRG grouper to further control the DRG payment method.Multiple measures will be taken to further reduce the expenses of lung cancer patients during their hospitalization to effectively reduce the medical burden.