云浮药品专区改革前后儿童呼吸系统疾病住院费用影响因素及其应对策略

Influencing factors and coping strategies of hospitalization expense of children with respiratory diseases before and after the reform of Yunfu drug zone

目的比较广东云浮市进行药品专区执行国家药品集中采购(GPO)前后呼吸系统疾病患儿住院医疗费用,分析其住院医疗费用的影响因素。方法选择云城区2019—2020年0~14岁城乡儿童呼吸系统疾病住院患儿,采用单因素和多元回归统计方法分析住院医疗费用的影响因素。结果呼吸系统疾病儿童平均住院医疗费用国家集采前(4872.38元)高于国家药品集采后(4620.25元,P<0.05),药费分别占参保及参合患儿住院医疗费用的35.35%和27.39%,统筹支付费用参保与参合儿童分别占46.85%和57.59%。年龄、住院天数、转归、有无合并症、疾病分类、应用GPO药物、入院分类为呼吸系统疾病患儿住院医疗费用的共同影响因素,其中住院医疗费用随着患儿年龄增加、转归良好及应用GPO药物费用而减少,为负性联系;余住院天数、有无合并症、疾病分类、入院分类则与住院总费用有着正性联系。结论提高患儿的转归,缩短平均住院日,做好药品专区及集中采购工作可降低儿童呼吸系统疾病的住院费用。

Objective To compare the inpatient medical expenses of children with respiratory diseases before and after the implementation of national group purchasing organization(GPO)in Yunfu City,Guangdong Province,and analyze the influencing factors of inpatient medical expenses.Methods The hospitalized children aged 0~14 with respiratory diseases from 2019 to 2020 in Yuncheng district implemented the GPO were selected.The influencing factors of hospitalization expense were analyzed by single factor and multiple regression statistical methods.Results The average hospitalization expense of children with respiratory diseases before the GPO implemented(4872.38 yuan)was higher than after(4620.25 yuan,P<0.05);the drug expense accounted for 35.35% and 27.39% of the hospitalization expense of the insured urban and rural children,and integrated payment accounted for 46.85% and 57.59%.Age,hospitalization days,outcome,comorbidities,disease classification,application of GPO drugs and admission classification were the common influencing factors of hospitalization expense of children with respiratory diseases.Hospitalization expense decreased with the increase of age,good outcome and application of GPO drugs,which was a negative correlation.And there was a positive relationship between the rest factors and the total cost of hospitalization.Conclusions To improve the outcome of children,shorten the average length of stay,doing a good job in drug zone and group procurement can reduce the hospitalization cost of children with respiratory diseases.