2011年-2019年某三甲综合医院小儿腹股沟疝住院费用影响因素分析

Analysis on the Influencing Factors of Hospitalization Expenses in Children with Inguinal Hernia in a Hospital from 2011 to 2019

目的对某三甲综合医院小儿腹股沟疝住院费用的影响因素进行分析,为医疗费用的合理化和医疗质量的提升提供依据。方法选择2011年1月1日至2019年12月31日某三甲综合医院收治的腹股沟疝患儿3088例,分析其住院费用构成,使用逐步回归通径分析模型分析住院费用的影响因素。结果住院时间中位数由5天下降至2天,住院费用由(5527.58±1344.28)元上升至(11640.13±1436.54)元。住院费用构成中,材料费从(627.63±305.99)元提高至(3297.10±566.26)元,占比由11.35%上升至28.33%;护理费从(73.85±20.49)元提高至(114.10±42.31)元,占比由1.34%下降至0.98%;药品费从2011年的(1545.69±490.73)元提高至2014年的(2944.34±773.73)元,后又逐年下降至2019年的(1913.24±470.53)元,占比由27.96%提高至30.08%又下降至16.44%;床位费从2011年的(157.49±64.66)元降低至2014年的(136.70±60.10)元,后又逐年上升至2019年的(147.54±91.36)元,占比由2011年的2.85%下降至2019年的1.27%,差异均具有统计学意义(P<0.001)。通径分析发现,影响住院费用的主要因素包括诊疗费、材料费和住院时间,总效应分别为0.523、0.455和0.641。结论住院时间、诊疗费、材料费均为影响小儿腹股沟疝住院费用的主要可控因素,提示临床中在确保医疗质量的条件下,应设法通过控制材料费、诊疗费以及住院时间等来控制总费用,减轻患者经济负担。

Objectives The factors influencing the hospitalization expenses of children with inguinal hernia in a Three A and Tertiary General Hospital were analyzed,so as to provide a basis for the rationalization of medical expenses and the improvement of medical quality of children with IH.Methods A total of 3088 children with inguinal hernia admitted to a Three A and Tertiary General Hospital from January 1st,2011 to December 31st,2019 were selected.The composition of hospitalization costs was analyzed.Step-based regression path analysis model was used to analyze the influencing factors of hospitalization costs.Results From 2011 to 2019,the median length of hospital stay was 3 days,decreased from 5 days to 2 days.The hospitalization expenses rose from(5527.58±1344.28)to(11640.13±1436.54)yuan.In the composition of hospitalization expenses,the cost of materials increased from(627.63±305.99)to(3297.10±566.26)yuan,the proportion increased from 11.35%to 28.33%,and the nursing fee increased from(73.85±20.49)to(114.10±42.31)yuan,the proportion decreased from 1.34%to 0.98%,and the cost of medicines increased from(1545.69±490.73)in 2011 to(2944.34±773.73)yuan in 2014,and decreased to(1913.24±470.53)yuan in 2019,the proportion increased from 27.96%to 30.08%and then dropped to 16.44%.The bed fee decreased from(157.49±64.66)in 2011 to(136.70±60.10)yuan in 2014,and then increased year by year to(147.54±60.10)yuan in 2019,the proportion dropped from 2.85%in 2011 to 1.27%in 2019,and the difference was statistically significant(P<0.001).Path analysis found that the proportion of diagnosis and treatment expenses,the proportion of material expenses and the length of stay were the main factors affecting hospitalization expenses,and the total effects were 0.523,0.455 and 0.641 respectively.Conclusions Hospitalization time,diagnosis and treatment costs,and material costs were the main controllable factors that affect the hospitalization costs of IH children,suggested that under the condition of ensuring the quality of medical treatment in clinic,we should try to control the total cost by controlling the cost of materials,diagnosis and treatment,and length of hospital stay,so as to reduce the economic burden.