2019—2021年上半年某三甲医院医疗费用结构变动度分析

Change analysis of medical income structure in a tertiary hospital from 2019 to the first half of 2021

目的分析新冠肺炎疫情“前-爆发-平战结合”阶段医院医疗费用结构变化,评价疫情期间医疗费用结构调整效果,为提高医院经济效益,控制医疗费用的过快增长提供参考依据。方法基于2019—2021年上半年医院收入结构数据,采用描述性统计和结构变动度进行分析。结果2020年上半年较2019年下半年门急诊月平均人次下降29.6%,住院月平均人次下降25.3%(P<0.05)。2021年上半年门急诊月平均人次恢复至2019年上半年水平(P>0.05),住院月平均人次仍较2019年上半年下降15.7%,手术月平均人次增长58.0%,四级手术月平均人次由59.5上升至134.0,微创月平均手术由175.0上升至241.0(P<0.05)。2019—2021年上半年门诊收入结构变动度为13.57%,年均门诊收入结构变动度为3.0%。2019—2021年上半年引起门诊费用结构变动较大的项目有药品收入、挂号收入、化验收入、卫生材料收入,累计贡献率87.10%,挂号费和化检收入的增加是推动医院门诊收入增长的主要因素;2019—2021年上半年住院收入结构变动度为11.89%,2019—2021年上半年引起住院费用结构变动较大的项目有药品收入、手术收入、治疗收入、化验收入,累计贡献率81.38%,手术收入和治疗收入的增加是医院住院收入增长的主要因素。结论新冠肺炎疫情下医院业务量急剧下降,医院应积极开展结构调整,降低药品及卫生材料消耗,提高手术及治疗收入,逐步优化医疗收入结构,提高医院经济效益。

Objective To analyze the changes of medical cost structure in the"pre-outbreak-peacetime and wartime combination"stages of COVID-19,and evaluate the effect of hospital structural adjustment in the latter stage,so as to provide reference for improving hospital economic benefits and controlling the rapid growth of medical costs.Methods Based on the data of hospital income structure from 2019 to the first half of 2021,descriptive statistics and structural variation analysis were used.Results In the first half of 2020,compared with the second half of 2019,the number of outpatient and emergency visits decreased by 29.6%,and the number of inpatients decreased by 25.3%(P<0.05).The number of outpatient and emergency visits in the first half of 2021 recovered to the level of the first half of 2019(P>0.05),the number of inpatients decreased by 15.7%,the number of operations increased by 58.0%,the number of grade 4 operations increased from 59.5 to 134.0,and the number of minimally invasive operations increased from 175.0 to 241.0(P<0.05).From 2019 to the first half of 2021,the variation degree of outpatient income structure was 13.57%,and the average annual variation degree of outpatient income structure was 3.0%.From 2019 to the first half of 2021,the items that caused great changes in the structure of outpatient fees were medicine income,registration income,laboratory income and sanitary material income,with a cumulative contribution rate of 87.10%.The increase of registration fees and chemical examination income was the main factor driving the growth of outpatient fees.From 2019 to the first half of 2021,the variation degree of inpatient income structure was 11.89%.From 2019 to the first half of 2021,the items that caused the big change of inpatient cost structure were medicine income,surgery income,treatment income and laboratory income,with a cumulative contribution rate of 81.38%.The increase of surgery income and treatment income was the main factor to accelerate the With the rapid decline of hospital business volume growth of inpatient income.Conclusion under the COVID-19 epidemic,hospitals should actively carry out the structural adjustment,reduce the consumption of drugs and sanitary materials,increase the income of surgery and treatment,gradually optimize the medical income structure,and improve the economic benefits of the hospital.