大同市某医院建档立卡贫困患者住院费用及影响因素分析

Analysis of Hospitalization Expenses and Influencing Factors of Poor Patients in a Hospital in Datong City

目的分析建档立卡贫困户住院患者特征和住院费用的影响因素。方法选取大同市某三级医院2018年1月—2019年12月住院的建档立卡贫困户患者1088例,描述住院特征,应用多元线性逐步回归和随机森林模型分析住院费用影响因素。结果2018—2019年建档立卡贫困户住院患者共1088人次,年龄中位数63岁。病种分类前3位是循环系统疾病、肿瘤和呼吸系统疾病。基本医疗保险支付1048人次,892.63万元;大病救助715人次,437.88万元;目录外补充基金支付1073人次,44.77万元;医保基金兜底904人次,280.08万元,基本医疗保险报销比例为47.94%。住院费用影响因素大小依次是住院日、是否手术、是否危重、诊断个数、是否外伤、年龄、性别(P<0.05)。结论建档立卡贫困户住院患者主要疾病类型为循环系统疾病、肿瘤和呼吸系统疾病,针对建档立卡贫困户的医疗救助政策切实减轻了其疾病经济负担。缩短住院天数和合理使用高值手术材料可有效降低建档立卡贫困户患者住院费用。

Objective To analyze the characteristics of inpatients and the influencing factors of hospitalization expenses in the poor households with registered cards.Methods 1088 patients from poor households who were hospitalized in a tertiary hospital in Datong City from January 2018 to December 2019 were selected.The characteristics of hospitalization were described,and the influencing factors of hospitalization expenses were analyzed using multiple linear stepwise regression and random forest model.Results From 2018 to 2019,a total of 1088 inpatients from poor households were registered,with a median age of 63 years.The top three categories of diseases are circulatory system diseases,tumors and respiratory system diseases.Basic medical insurance paid 1048 person-times,8926300 yuan;715 people received serious illness relief,4378800 yuan.Supplementary funds outside the catalog paid 1073 person-times,447700 yuan.The medical insurance fund covered 904 person-times,2800800 million yuan,and the basic medical insurance reimbursement ratio was 47.94%.The influencing factors of hospitalization expenses were the length of hospital stay,whether surgery,whether it was critical,the number of diagnoses,whether there was trauma,age,and gender(P<0.05).Conclusion The main disease types of inpatients from the registered poor households are circulatory system diseases,tumors and respiratory system diseases.The medical assistance policy for the registered poor households has effectively reduced the economic burden of their diseases,shortening the length of hospital stay and rational use of high-value surgical materials can effectively reduce the hospitalization costs for patients from poor households who have been registered.