上海市肺结核患者门诊直接医疗费用及其构成

Outpatient Direct Medical Expenditures and Their Composition of Patients with Pulmonary Tuberculosis in Shanghai

目的:了解上海市肺结核患者门诊直接医疗费用及构成,分析其影响因素,为完善肺结核病防治工作,推动医疗费用及其结构进一步合理化提供依据。方法:收集2013年1月起上海市4个示范区新登记肺结核病患者完成治疗后的医疗费用发票凭证,并采用问卷调查患者的基本信息。结果:共获得766名肺结核病患者信息。患者门诊直接医疗费用均值为5450.9元,中位数为4605.3元;药费在门诊直接医疗费用中占67.5%,化验费和检查费分别占18.1%和12.1%;保肝药在西药、中成药费用中占比均高于抗结核药费用,分别为57.1%和60.8%;CT在检查费中占比高达82.9%;广义线性回归分析显示,主要就诊机构级别和门诊就诊次数对肺结核患者门诊直接医疗费用的影响具有统计学意义(P<0.05)。结论:辅助药品在门诊直接医疗费用中占比较高,检查费以CT为主;主要就诊机构级别是影响患者门诊直接医疗费用的重要因素;门诊就诊次数对患者门诊直接医疗费用具有影响;上海市肺结核患者门诊直接医疗费用水平及影响因素与其他地区存在差异。

Objective:To understand the outpatient direct medical expenditures and their composition of patients with pulmonary tuberculosis in Shanghai,and to analyze their influencing factors,so as to provide references for improving the prevention and treatment of pulmonary tuberculosis and promoting the further rationalization of medical expenditures and structure.Methods:All the invoices of medical expenditures after completion of treatment of the newly registered patients with pulmonary tuberculosis from January 2013 in 4 demonstration areas in Shanghai were collected and a questionnaire survey was conducted to investigate the basic information of the patients.Results:A total of the information of 766 patients with pulmonary tuberculosis were obtained.The outpatient direct medical expenditures of patients with pulmonary tuberculosis was 5450.9 yuan on average with the median of 4605.3 yuan.The costs of medicine accounted for 67.5%of the outpatient direct medical expenditures,and the costs of diagnostic test and the costs of examination accounted for 18.1% and 12.1% respectively.The proportion of the costs of hepatoprotective drugs in the costs of Western medicine and Chinese medicine was higher than that of anti-tuberculosis drugs(57.1% and 60.8% respectively).CT accounted for 82.9%of the costs of examination.Generalized linear regression revealed that the level of major visited medical institutions and the time of outpatient visiting had statistical significance on the outpatient direct medical expenditures of patients with pulmonary tuberculosis(P<0.05).Conclusion:Auxiliary drugs account for a large proportion in the outpatient direct medical expenditures and the costs of examination are mainly CT.The level of major visited medical institutions is an important factor affecting the outpatient direct medical expenditures.The time of outpatient visiting has an impact on the outpatient direct medical expenditures.The level and influencing factors of the outpatient direct medical expenditures of patients with pulmonary tuberculosis in Shanghai are different from those of other regions.