基于卫生费用核算体系2011的甘肃省糖尿病治疗费用核算研究

Study on calculating the curative care expenditure of diabetes in Gansu Province on the basis of a System of Health Accounts 2011

目的探讨甘肃省2018年糖尿病治疗费用的总体规模、人群分布、机构流向及影响因素,为合理减轻糖尿病治疗费用负担提供科学依据。方法本研究基于卫生费用核算体系2011(SHA 2011),汇总卫生健康财务年报、卫生健康统计年鉴等总量资料,并采取多阶段分层整群抽样方法获取1 086家医疗卫生机构的糖尿病患者病历信息。采用Stata 14.0软件核算出甘肃省2018年糖尿病的治疗费用,采用Mann-Whitney U检验和Kruskal-Wallis H检验及多重线性回归分析住院费用的影响因素。结果甘肃省2018年糖尿病治疗费用为134 775.11万元,其中54.12%用于门诊治疗;糖尿病治疗费用的90.16%集中分布在45岁及以上中老年人群,20~80岁患者年人均治疗费用为1 288.97元;男性糖尿病治疗费用高于女性;86.89%的糖尿病治疗费用流向医院,而基层医疗卫生机构占比较小,为12.49%;不伴有并发症的糖尿病患者治疗费用占比最高,为62.74%,其次为伴有多种并发症者。多重线性回归分析结果显示,住院天数长(β=0.421)、年龄高(β=0.097)、手术(β=0.093)、药占比高(β=0.088)、医保支付(β=0.043)以及伴有并发症(β=0.037)的患者住院费用高;而县(区)级及以下医疗机构(β=-0.613)和市级医疗机构(β=-0.273)较省级医疗机构,基层医疗卫生机构(β=-0.187)和专科医院(β=-0.079)较综合医院的患者住院费用低,均有统计学意义(P<0.01)。结论甘肃省中老年人群糖尿病治疗费用负担较重,应对经济欠发达地区给予更多政策扶持;治疗费用主要流向医院,增加基层机构应对能力刻不容缓。

Objective To explore the total scale,population distribution,and classification of health care providers and influencing factors of the curative care expenditure for diabetes in Gansu Province in 2018,and to provide the scientific basis for reasonably reducing the burden of diabetes costs. Methods On the basis of a System of Health Accounts 2011(SHA 2011),the present study aggregated macro data from official statistics such as Health Financial Annual Reports and Health Statistical Yearbooks,and the multi-stage stratified cluster sampling method was used to obtain the medical records of diabetic patients from 1 086 medical and health institutions. The treatment cost of diabetes in Gansu Province in 2018 was calculated,Mann-Whitney U test,Kruskal-Wallis H test and multiple linear regression were used to analyze the influencing factors of hospitalization costs. The used software was Stata 14.0. Results In 2018,the curative care expenditure of diabetes in Gansu Province was 1 347.75 million yuan,54.12% of curative care expenditure was used for outpatient treatment;90.16% of the cost of diabetes treatment was mainly used for the patients with ≥45 years old,and the annual per capita cost of treatment for patients with 20-80 years old was 1 288.97 yuan;the diabetes treatment cost of male patients was higher than that of female patients;86.89% of the cost was used in hospitals,and the cost proportion in basic-level health care institution was less(12.49%);the percentage(62.74%) of treatment costs for diabetes patients without complications was the highest,then the second was for diabetes patients with multi-complications. Multiple linear regression results showed that longer duration of hospitalization (β =0.421),higher age (β =0.097),operation (β =0.093),higher proportion of drugs (β=0.088),health insurance payment (β=0.043 ) and complications (β=0.037) increased hospitalization costs;as compared with provincial institutions,county(district) and lower level institutions (β=-0.613) and municipal institutions(β=-0.273) reduced hospitalization costs,and as compared with general hospitals,primary health care institutions (β=-0.187)and specialized hospitals (β=-0.079) reduced hospitalization costs(P<0.01). Conclusion The middle-aged and elderly bear a heavier economic burden of diabetes treatment,and more policy support should be given to less economically developed areas. The medical expenses for diabetes are mainly consumed in the hospitals,and it is imperative to increase the capacity of primary health care providers.