综合医院和中医类医院日间手术病种住院费用及结构的对比分析

Comparative analysis of hospitalization expenses and structure of day surgery diseases between general hospital and traditional Chinese medicine hospital

目的 对综合医院和中医类医院日间手术病种住院费用及结构进行分析,为中医医疗保险支付方式改革政策制定和医院经营管理优化提供依据。方法 选取上海市1家综合医院与1家中医类医院2019年1月1日-2022年6月30日的日间手术住院费用、费用结构等相关数据,分析中医类医院与综合医院日间手术住院费用及结构。结果 共纳入日间手术患者95 232例,包括中医类医院患者1 389例和综合医院患者93 843例。中医类医院日间手术患者的年龄比综合医院患者小(P<0.001)。中医类医院日间手术患者的住院总费用[4 379.6(2 293.2,7 563.4)vs. 7 629.5(4 467.5,14 154.0)元]、药品费用[343.0(65.0,1 107.0)vs. 749.0(64.0,1 419.0)元]、耗材费用[858.8(162.2,1 630.1)vs. 1 951.0(620.1,5 720.7)元]、技术劳务性费用[1 994.8(1 116.8,3 252.4)vs. 3 943.3(2 510.8,6 123.4)元]比综合医院患者低(P<0.001),检查检验费用比综合医院患者高[432.0(0.0,898.5)vs. 40.0(0.0,418.0)元,P<0.001]。日间手术患者住院总费用结构方面,中医类医院以技术劳务性费用占比最高(42.5%);综合医院以耗材费用占比最高(43.7%)。中医类医院日间手术开展的专业以妇科、普外科、肛肠科、疼痛科为主,均次费用以眼科最高。综合医院日间手术开展的专业以泌尿外科、胆胰胃肠外科、眼科、妇科为主,均次费用以骨科最高。中医类医院痔切除术日间手术患者年龄与综合医院差异无统计学意义(P>0.05)。中医类医院痔切除术日间手术患者的住院总费用[7 177.4(6 057.5,8 225.7)vs. 10 730.3(8 895.7,14 291.4)元]、药品费用[838.0(441.0,1 342.0)vs. 1 532.0(1 335.0,1 698.0)元]、耗材费用[4 518.7(4 268.3,5 084.9)vs. 5 550.9(4 066.6,8 340.7)元]、技术劳务性费用[1 138.8(911.3,1 414.2)vs. 3 793.9(2 997.1,4 410.3)元]比综合医院患者低(P<0.05),检查检验费用比综合医院患者高[329.0(0.0,598.0)vs. 40.0(40.0,40.0)元,P<0.05]。痔切除术日间手术患者住院总费用结构方面,中医类医院和综合医院均以耗材费用占比最高(分别为63.8%和53.6%)。结论 中医类医院日间手术的住院费用与综合医院存在差异。中医类医院日间手术优势病种有待进一步培育,未来在中医医疗机构推行按医疗保险疾病诊断相关分组/病种分值付费时,应充分结合医疗机构实际情况与病种特点,同时需进一步建立基于病种质量评价的医疗精细化管理。

Objective To analyze the hospitalization expenses and structure of day surgery diseases between general hospital and traditional Chinese medicine hospital, so as to provide a basis for the reform policy formulation of the payment mode of traditional Chinese medicine medical insurance and the optimization of hospital management.Methods Relevant data such as hospitalization expenses and expenses structure of day surgery of one general hospital and one traditional Chinese medicine hospital in Shanghai between January 1, 2019 and June 30, 2022 were selected. The hospitalization expenses and expenses structure of day surgery in traditional Chinese medicine hospital and general hospital were analyzed. Results A total of 95 232 day surgery cases were selected in the case hospitals, including 1 389cases in traditional Chinese medicine hospital and 93 843 cases in general hospital. The age of day surgery patients in traditional Chinese medicine hospital was smaller than that in general hospital(P<0.001). The total hospitalization expenses[4 379.6(2 293.2, 7 563.4) vs. 7 629.5(4 467.5, 14 154.0) yuan], drug expenses [343.0(65.0, 1 107.0) vs. 749.0(64.0, 1 419.0)yuan], consumables expenses [858.8(162.2, 1 630.1) vs. 1 951.0(620.1, 5 720.7) yuan], technical labor expenses [1 994.8(1 116.8,3 252.4) vs. 3 943.3(2 510.8, 6 123.4) yuan] of day surgery patients in traditional Chinese medicine hospital were lower than those of patients in general hospital(P<0.001), and the examination expenses were higher than those of patients in general hospital [432.0(0.0, 898.5) vs. 40.0(0.0, 418.0) yuan, P<0.001]. In terms of the total hospitalization expenses structure of patients undergoing day surgery, the proportion of technical labor expenses in traditional Chinese medicine hospital was the highest(42.5%), and the proportion of consumables expenses in general hospital was the highest(43.7%). The specialty of day surgery in the traditional Chinese medicine hospital mainly focused on gynecology, general surgery, anorectal surgery and pain medicine, with the highest average expenses in ophthalmology. The specialty of day surgery in the general hospital mainly focused on urology, biliary, pancreatic and gastrointestinal surgery, ophthalmology and gynecolog,with the highest average expenses in orthopedics. There was no statistically significant difference between the age of patients undergoing hemorrhoidectomy in traditional Chinese medicine hospital and that in general hospital(P>0.05).The total hospitalization expenses [7 177.4(6 057.5, 8 225.7) vs. 10 730.3(8 895.7, 14 291.4) yuan], drug expenses [838.0(441.0,1 342.0) vs. 1 532.0(1 335.0, 1 698.0) yuan], consumables expenses [4 518.7(4 268.3, 5 084.9) vs. 5 550.9(4 066.6, 8 340.7)yuan], technical labor expenses [1 138.8(911.3, 1 414.2) vs. 3 793.9(2 997.1, 4 410.3) yuan] of day surgery patients undergoing hemorrhoidectomy in traditional Chinese medicine hospital were lower than those of patients in general hospital(P<0.05), and the examination expenses were higher than those of patients in general hospital [329.0(0.0, 598.0)vs. 40.0(40.0, 40.0) yuan, P<0.05]. In terms of the total hospitalization expenses structure of day surgery patients undergoing hemorrhoidectomy, the highest proportion was consumables expenses both in traditional Chinese medicine hospital and general hospital(63.8% and 53.6%, respectively). Conclusions There are differences between the hospitalization expenses of day surgery in traditional Chinese medicine hospital and general hospital. The dominant disease types of day surgery in traditional Chinese medicine hospitals need to be further cultivated. In the future, when the traditional Chinese medicine medical institutions implement the payment according to the diagnosis-related group/diagnosis-intervention packet, they should fully combine the actual situation of the medical institutions and the characteristics of the disease type, and at the same time, they need to further establish the medical fine management based on the disease type quality evaluation.