新疆某三甲医院食管癌患者住院费用及影响因素分析

Analysis on Hospitalization Cost and Influencing Factors of Esophageal Cancer Patients in a Third Class Hospital of Xinjiang

目的探究新疆乌鲁木齐市某三甲综合医院食管癌患者住院费用的构成及影响因素,为控制食管癌患者住院费用提供参考依据。方法对2014年1月1日-2019年12月31日期间某院住院病案首页中主要诊断为食管癌的1617例患者的基本信息、住院费用及影响因素采用描述性分析、单因素和多重线性回归分析。结果食管癌患者的平均住院费用为42 744.91元;人均住院费用总体呈上升趋势,从2014年的36 591.11元增长至2019年的55 854.36元,其中药品费、材料费、治疗费是构成住院费用的主要项目;护理费和手术费的年均增长率最大,分别为28.68%、15.72%。单因素分析显示影响住院费用的因素包括民族、年龄、入院年份、住院天数、付费方式、是否有合并症、是否转科、是否手术,差异具有统计学意义,P<0.05;通过多重线性回归分析显示手术治疗和住院天数是影响食管癌患者住院费用的主要因素,同时付费方式也对住院费用产生一定的影响。结论政府部门需持续加强药品及卫生耗材的监督管理来直接控制住院费用的增长,同时积极开展食管癌筛查和宣教工作,提高疾病预防能力并帮助早期患者及时就诊。医院内部可以通过提升精细化管理水平、实施临床路径、提升服务效率等方法减少住院时间从而有效控制住院费用。医保部门应将更多的抗癌药物纳入报销范围以缓解患者的疾病经济负担,并推进支付方式改革来规范诊疗行为,达到降低食管癌患者住院费用的目的。

Objective To explore the composition and influencing factors of hospitalization expenses of esophageal cancer patients in a third Class A General Hospital in Urumqi, Xinjiang, and to provide a reference for controlling the hospitalization expenses of esophageal cancer. Methods Descriptive analysis, single factor and multiple linear regression analysis were used to analyze the basic information, cost and influencing factors of 1617 patients diagnosed as esophageal cancer from January 1, 2014 to December 31, 2019. Results The average hospitalization cost of esophageal cancer patients was 42744.91 yuan;From 2014 to 2019, the per capita hospitalization expenses increased from 36591.11 yuan to 55854.36 yuan, among which drug, material and treatment expenses were the main items that constituted the hospitalization expenses;The largest annual growth rate of care and surgery costs, which was 28.68% and 15.72%. A single factor analysis showed that the factors affecting the cost of hospitalization included nationality, age, year of admission, length of stay, mode of payment, whether they had complication, whether they were transferred and surgery(P<0.05);Multiple linear regression analysis results show: Whether surgical treatment and hospitalization days are the main factors affecting the hospitalization cost of esophageal cancer patients;In addition, the way of payment also has a certain impact on hospital expenses. Conclusion Government departments need to continuously strengthen the supervision and management of drugs and health consumables, which can directly control the increase of hospitalization expenses, at the same time, actively carry out esophageal cancer screening and education work to improve the ability of disease prevention and help early patients to see a doctor in time. For medical institutions, hospital expenses can be effectively controlled by improving fine management level, implementing clinical pathway and improving service efficiency. The medical insurance department should bring more anticancer drugs into the reimbursement scope to alleviate the economic burden of patients’ diseases, and promote the reform of payment methods to standardize the diagnosis and treatment behavior, so as to reduce the hospitalization expenses of esophageal cancer patients.