基于按病种分值付费下的学龄前儿童医保住院患者医疗费用分析及相关因素探索

Medical expenses of preschool children patients under payment system of Big Data Diagnosis Intervention Package and the relevant factors

目的分析按病种分值付费制度下,学龄前儿童医保住院患者的医疗费用结构,并探索其费用相关因素,为妇幼专科医院进行学龄前儿童医疗费用的控制提供参考。方法以广州市某三级妇幼专科医院2018年1月—2020年12月期间的学龄前儿童医保住院患者的医疗费用为研究对象,对其费用进行描述性分析、结构比分析,采用秩和检验及二分类Logistic回归探索与其费用相关的因素。结果医疗费用构成分析结果显示,学龄前儿童医保住院患者的费用构成中,治疗费(28.73%)、化验费(17.73%)、西药费(15.02%)占比较高,而输血费(0.23%)、中药费(0.17%)、其他费用(0.04%)占比较低。单因素及多因素分析结果显示,性别为男性、年龄为0~2岁,入院病情为危急、治疗效果为死亡/转院、有院内感染、有手术治疗、住院时间为1 w以上等指标与学龄前儿童医保住院患者的医疗费用相关,且会带来住院费用的上升(OR>1,P<0.05)。结论应在保证医疗质量的基础上,根据学龄前儿童的不同人口学特征(性别、年龄)、不同疾病程度(入院病情)、不同治疗因素(治疗效果、有无院内感染、有无手术治疗、住院时间)等采取针对性的医疗控费举措,以更好地实现医保控费目标。

Objective To analyze the medical cost compositions of medically insured preschool children patients under the payment system of Big Data Diagnosis-Intervention Package(DIP)and explores the relevant factors of the medical cost so as to provide reference for controlling their medical expenses in Maternal and Child Care Service Centers.Methods The medical expenses of the preschool in-patients in a Maternal and Child Care Service Center in Guangzhou from January 2018 to December 2020 were analyzed by descriptive analysis and structure ratio analysis,and the relevant factors were explored by rank sum test and binary logistic regression.Results Among the expense compositions of those preschool in-patients,the treatment expense,laboratory expense and western medicine expense composed the relatively high proportions by 28.73,17.73%and 15.02%,respectively,while the blood transfusion expense,traditional Chinese Medicine expense and other expenses the relatively low proportions by 0.23%,0.17%and 0.04%.By univariate and multivariate analyses,the relevant factors influencing their medical cost were male,age of 0-2 years,critical conditions at admission,death or transfer to other medical centers,nosocomial infection,surgical treatment and hospital stay for more than one week,which were likely to lead to an increase in the hospital expenses(OR>1,P<0.05).Conclusion With the premise of ensured medical quality,targeted medical cost control measures should be taken according to the preschooler’s demographic characteristics like gender and age,disease conditions at admission and treatment factors like treatment effect,nosocomial infection,surgical treatment and hospital stay so as to better achieve the goal for medical insurance cost control.