2017—2019年河南省某贫困县县级医疗机构高血压及其合并症、并发症患者住院人次数及住院费用分析

Number and Costs of Hospitalizations Due to Hypertension and Related Comorbidities and Complications in County-level Healthcare Institutions in a Poverty-stricken County in Henan from 2017 to 2019 LIU Rongmei1,MAO Yanna2,

背景2018年,我国≥18岁成人高血压加权患病率为27.5%,农村地区高血压患病率增长速度快于城市,且高血压知晓率、治疗率和控制率较低。高血压是心血管疾病的首要危险因素,同时也是造成人群疾病负担的首要因素。了解农村区域因高血压及其合并症、并发症住院患者的住院费用情况,可为县域制定高血压管理及防控策略提供数据支撑。目的分析县级医疗机构因高血压及其合并症、并发症住院患者的住院费用。方法于2017—2019年在河南省某贫困县人民医院及县中医院,选择病案首页中诊断为高血压患者人群作为研究对象,提取患者相关信息,同时收取市、县医保信息系统中相关的费用信息。结果共获取36565人次住院患者相关信息。总体来看,2017—2019年,县级医疗机构3年累计总住院人次为139169人次,高血压患者累计总住院人次为36565人次(26.27%)。2017—2019年因高血压及其合并症、并发症住院患者年龄、职业类型、婚姻状况、支付方式比较,差异有统计学意义(P<0.05)。不同性别、年龄、职业类型、婚姻状况、入院年份、支付方式的因高血压及其合并症、并发症住院患者病情程度比较,差异有统计学意义(P<0.05)。2017—2019年,因高血压及其并发症、合并症住院患者次均住院费用分别为7364.88、6724.36、7134.09元;因高血压及其并发症、合并症住院患者住院总费用攀升,分别为62653116.87、84394889.48、109633058.60元;因高血压及其合并症、并发症住院患者医保报销在全县医保报销费用中占比分别是24.86%、31.41%、33.25%,呈现逐年上升趋势。不同年份因高血压及其合并症、并发症住院患者次均住院费、治疗费、药品费比较,差异有统计学意义(P<0.05);次均检查费比较,差异无统计学意义(P>0.05)。2017—2019年,不同疾病程度因高血压及其合并症、并发症住院患者次均住院费、治疗费、药品费、检查费比较,差异均有统计学意义(P<0.05)。结论2017—2019年县级医疗机构因高血压及其合并症、并发症住院患者累计总住院人次占比较高,且因高血压及其合并症、并发症住院患者住院总费用及医保报销占比逐年上升。亟须加强对已确诊高血压患者规范化管理,提高基层医疗卫生机构发现、确诊、管理高血压患者的能力,通过延缓高血压患者病情进展达到降低医药卫生费用的目的;关注特殊群体,减轻高血压患者疾病负担,提高特殊群体身体健康水平;多措并举,提升全域居民健康意识及自我健康管理能力。

Background In 2018,the weighted prevalence rate of hypertension among adults aged≥18 years was 27.5%.Rural areas demonstrated a faster increase in the prevalence rate of hypertension,but lower awareness rate,treatment rate and control rate of hypertension compared with urban areas.Hypertension is the primary risk factor for cardiovascular diseases,and also a major contributor to the disease burden in the population.Understanding the costs of hospitalizations due to hypertension and related comorbidities and complications in rural areas can provide data support for the development of hypertension management and containment strategies in counties.Objective To analyze the costs of hospitalizations due to hypertension and related comorbidities and complications in county-level healthcare institutions.Methods This study selected inpatients with a diagnosis of hypertension via checking the home page of medical records in two county-level hospitals(people's hospital and TCM hospital)of a poverty-stricken county in Henan Province from 2017 to 2019.Patients'clinical information was collected from the medical records,and their healthcare costs were collected from the municipal and county medical insurance information systems.Results A total of 36565 hospitalizations related information was obtained.During the period,these county-level healthcare institutions had 139169 hospitalizations in total,36565 of them(26.27%)were due to hypertension and related comorbidities and complications.Age,occupational type,marital status,and payment method differed significantly across inpatients due to hypertension and related comorbidities and complications(P<0.05).The severity of disease varied significantly among patients hospitalized due to hypertension and related comorbidities and complications by gender,age,occupational type,marital status,year of admission,and payment method(P<0.05).The average cost of hospitalization due to hypertension and related comorbidities and complications was 7364.88 yuan in 2017,6724.36 yuan in 2018,and 7134.09 yuan in 2019.And total costs of hospitalizations due to hypertension and related comorbidities and complications in the three years were 62653116.87 yuan,84394889.48 yuan and 109633058.60 yuan,respectively,showing an increase trend,and the percent of which reimbursed by health insurance was 24.86%in 2017,31.41%in 2018,and 33.25%in 2019,demonstrating an increasing trend year by year.The average hospitalization expenses,treatment expenses,and drug expenses due to hypertension and related comorbidities and complications differed significantly by year(P<0.05),while the average examination expenses did not(P>0.05).Moreover,the average hospitalization cost,treatment cost,drug cost and examination cost due to hypertension and related comorbidities and complications differed significantly by the severity of disease during the period(P<0.05).Conclusion In these county-level healthcare institutions during the period,the number of hospitalizations due to hypertension and comorbidities and complications accounted a large percent of the total hospitalizations,and the percentages of relevant hospitalization costs and reimbursed costs showed an increase trend gradually.In view of this,it is suggested to strengthen the standardized management of people with a definite diagnosis of hypertension,enhance the capacities of primary medical institutions in identifying,diagnosing and managing hypertension,and reduce healthcare costs by delaying the progression of hypertension.Moreover,priority should be given to special groups to improve their health status to reduce the disease burden of hypertension,and multiple measures should be taken to improve people's awareness rate of hypertension and self-health management abilities.