不同营养支持方式外科手术患者医疗费用负担水平比较研究

Comparative Study on the Medical Expenses Burden of Surgical Patients with Different Nutritional Support Methods

目的对不同营养支持方式的外科手术患者医疗费用负担水平进行比较分析,为加强外科手术患者合理营养支持管理提供参考。方法收集内蒙古某三甲医院2019年1月1日—12月31日普通外科手术患者住院日、医疗费用数据与医疗保险报销数据。采用中位数对各项指标进行统计学描述,组间比较采用Kruskal-Wallis H检验。结果共收集普通外科手术患者2077人次。不同营养支持方式外科手术患者在住院日、药品费用、材料费用、检查费用、化验费用、治疗费用和其他费用间差异均具有统计学意义(P<0.05),各组别医疗总费用、医保负担费用、医保负担比例、患者负担比例间差异均具有统计学意义(P<0.05)。结论加强外科手术患者术后合理营养支持治疗,有助于缩短患者住院时间,降低患者医疗费用个人负担比例,但外科手术患者医疗费用结构应进一步优化,卫生管理部门、医保管理机构等应加强营养支持类药品采购、临床使用、医保报销等环节的监管,降低外科手术营养支持患者药品费用水平。

Objective To compare and analyze the medical expense burden of surgical patients with different nutritional support methods,to provide reference for strengthening the management of reasonable nutritional support for surgical patients.Methods Hospitalization day,medical expense and medical insurance reimbursement data of general surgery patients in a tertiary hospital in Inner Mongolia from January 1 to December 31,2019 were collected.Median was used for statistical description of each index,and Kruskal-Wallis H test was used for comparison among groups.Results A total of 2077 general surgery patients were included.Among different nutritional support methods in surgical patients,the length of stay,pharmaceutical cost,material cost,examination cost,test cost,treatment cost and other fees had significant difference(P<0.05).Among groups,the total medical cost,medical insurance burden cost,proportion of medical insurance burden and proportion of patient burden had statistically significant(P<0.05).Conclusion Strengthening reasonable surgical patients postoperative nutritional support treatment helps to shorten length of stay,reduce the burden of patient’s personal medical expense proportion.However,surgery patient’s medical expenses structure should be further optimized,health administrative departments and health insurance management institutions should strengthen the supervision on nutritional support drug purchase,clinical use and insurance reimbursement,to reduce the level of drug costs for patients receiving nutritional support during surgery.