基于结构变动度及灰色关联分析的青岛市某三甲医院宫颈癌手术患者住院费用研究

Analysis on the Hospitalization Expenses of Cervical Cancer Patients in a Grade A Tertiary Hospital of Based on Structural Change Degree and Grey Correlation

目的对宫颈癌手术患者住院费用的结构变化及原因进行分析,为管控医疗费用,实施DIP、DRG支付方式改革提供依据。方法采用结构变动度及灰色关联法对2015—2020年青岛市某三级甲等医院6623例宫颈癌手术患者住院费用结构变化情况及关联度进行定量分析。结果2015—2020年,住院费用结构变动度为34.60%;治疗费、药品费、耗材费、诊断费4项费用累计结构变动贡献率为93.54%,其中治疗费累计贡献率最大为33.99%。综合医疗服务费、诊断费、治疗费呈现正向贡献变动,药品费、耗材费、血液和血液类制品费对费用结构呈现负向贡献变动;6年间影响宫颈癌手术患者住院费用关联度排前两位的是治疗费、诊断费。结论宫颈癌手术患者住院费用结构符合改革预期,费用结构趋向合理,但仍有优化空间。建议注重医用耗材和药品合理使用,规范医师诊疗行为,积极推进医保支付制度改革,提高医师技术劳务价值,进一步优化费用结构。

Objective To analyze the structural changes and reasons for hospitalization expenditure among patients with cervical cancer,so as to provide evidence for controlling medical expenses and implementing DIP,DRG,and other payment methods reforms.Methods The degree of structural change and the grey correlation method were used to quantitatively analyze the changes in the structure of hospitalization expenses and the degree of correlation of 6623 patients with cervical cancer surgery in a tertiary hospital in Qingdao from 2015 to 2020.Results In 2015-2020,the structure change rate of hospitalization expenses in 6 years was 34.60%;the cumulative structure change contribution rate of the 4 items of treatment,medicine,consumables,and diagnosis expenses was 93.54%,of which the cumulative contribution rate of treatment expenses was 33.99%.Comprehensive medical service fees,diagnosis fees,and treatment fees showed positive contribution changes.Drug fees,consumables,and blood and blood product fees showed negative contributions to the cost structure;in the past 6 years,the top two factors affecting the hospitalization cost of cervical cancer surgery patients were the treatment cost and the diagnosis cost.Conclusion The structure of hospitalization expenses for patients undergoing cervical cancer surgery is in line with reform expectations,and the expense structure tends to be reasonable,but there is still room for optimization.It is recommended to pay attention to the rational use of medical consumables and drugs,standardize physicians’diagnosis and treatment behavior,actively promote the reform of the medical insurance payment system,improve the technical value of medical staff,and further optimize the cost structure.