某市中医医院与综合医院恶性肿瘤化疗患者住院费用结构对比分析

Comparative Analysis of Hospitalization Cost Structure of Malignant Tumor Patients with Chemotherapy in Beijing Traditional Chinese Hospitals and Western Medicine Hospitals

目的了解中医医院与综合医院恶性肿瘤化疗患者的住院费用结构差异,分析中医医院治疗该类患者的特色及优势,为多元化付费制度下该类患者的中医医院病组定价提供建议。方法在2019年1月1日-2019年12月31日某市部分中医医院与综合医院出院患者病案首页数据中筛选出主要诊断恶性肿瘤化疗的患者共21.9万例,描述中医医院与综合医院2组样本的患者基本信息特征,采用结构差异度法对2组样本的费用结构差异进行分析。结果中医医院的患者年龄、合并症数量、住院天数均显著高于综合医院。中医医院与综合医院的费用结构差异主要来源于药品费,其中西药、中成药、中草药3类费用的结构差异贡献率分别为41.74%、20.03%、9.26%,综合医疗服务费、诊断费结构差异贡献率分别为7.7%、6.7%,累积贡献率85.4%。结论中医医院主要以中成药、中草药作为恶性肿瘤化疗患者的辅助治疗用药,综合医院则以细胞因子类制品作为辅助治疗。中医医院应以恶性肿瘤化疗病种为例,借助费用结构差异度方法,整理中医优势特色病组,为中医医院纳入多元付费制度做好准备。

Objectives This study aims to understand the difference in the cost structure between TCM(Traditional Chinese medicine)hospitals and western medicine hospitals in the treatment of malignant tumor chemotherapy,analyze the characteristics and advantages of TCM hospitals in the treatment of such patients,and provide suggestions for the pricing of the disease category in TCM hospitals under the diversified payment system.Methods 219000 malignant tumor patients treated with chemotherapy in partial TCMs and general hospitals in a city from January 1,2019 to December 31,2019 were selected from the front-page data in the medical record database.The basic information characteristics of patients in two groups of samples from TCM hospitals and western medicine hospitals were described.The cost structure differences between the two groups of samples were analyzed using the structural difference method.Results The patients’age,number of complications and length of stay in TCM hospitals were significantly higher than those in the western medicine hospitals.The difference in the cost structure between TCM hospitals and western medicine hospitals mainly came from drug cost.The contribution rates of structural difference of western medicine,Chinese patent medicine and Chinese herbal medicine were 41.74%,20.03%and 9.26%,respectively.The contribution rates of structural difference of comprehensive medical service fee and diagnosis fee were 7.7%and 6.7%,respectively.The cumulative contribution rate was 85.4%.Conclusions TCM hospitals mainly use Chinese patent medicine and Chinese herbal medicine as adjuvant chemotherapy drugs,while western medicine hospitals use cytokine products as adjuvant treatment.TCM hospitals should take malignant tumor chemotherapy diseases as an example to sort out their advantageous and characteristic disease groups with the help of the cost structure difference method and prepare for the multi payment system.