病种分值付费下子宫壁内平滑肌瘤手术患者住院费用的影响因素

Analysis on the Hospitalization Expenses and Influencing Factors of Myomectomy Patients Using Diagnosis-intervention Packet Payment

目的 分析按病种分值付费下子宫壁内平滑肌瘤手术患者住院费用构成及影响因素,为合理控制住院费用提供依据。方法 收集广州市某医院2019年1月1日-2020年12月31日实行按病种分值付费结算子宫壁内平滑肌瘤手术患者302例,利用单因素分析和多重线性回归方法对住院费用影响因素进行分析。结果 子宫壁内平滑肌瘤患者平均住院费用为27 558.5元,最小值为17 398.6元,最大值为40 236.0元;手术患者住院费用构成前4位分别为材料费(26.9%)、手术费(21.3%)、药费(14.4%)和检验费(12.9%)。多因素分析显示住院天数、年龄、出院年份、手术方式是住院费用的主要影响因素。结论 子宫壁内平滑肌瘤手术患者住院费用偏高,费用构成不合理,要合理控制材料费、药费和检查费。住院天数是影响住院费用最重要的因素,实施临床路径缩短住院天数是控制住院费用的重要措施。

Objectives This study aims to analyze the hospitalization cost composition and the influencing factors of myomectomy patients using diagnosis-intervention packet payment in order to provide basis for reasonable control of hospitalization expenses. Methods 302 myomectomy patients with diagnosis-intervention packet(DIP) payment in a hospital in Guangzhou from January 1, 2019, to December 31, 2020 were collected. One factor analysis and multiple linear regression were used to analyze the composition and influencing factors of hospitalization cost.Results The average hospitalization expenses for myomectomy patients were 27558.5 yuan, with the minimum of 17398.6 yuan and the maximum of 40236.0 yuan. The top four sources of the myomectomy patients’ hospitalization costs were materials(26.9%), operation(21.3%), medication(14.4%), and inspection(12.9%). The results of multivariate analysis showed that hospitalization days, age, discharge year and surgical procedure categories were the main influencing factors of hospitalization expenses. Conclusions The hospitalization expenses for myomectomy patients are high and the composition of hospitalization cost is unreasonable. It is necessary to have reasonable control of material cost, medication cost, and inspection cost. The most important influencing factor of the hospitalization cost is the length of stay. The implementation of clinical pathways to shorten the length of hospital stay is an important measure to control the hospitalization cost.