2018-2021年河南省某综合性三甲医院住院费用结构变动度分析

Analysis on the Degree of Structure Variation of Hospitalization Expenses in a Comprehensive Tertiary Hospital in Henan Province from 2018 to 2021

目的分析住院患者次均费用的结构变动情况,为优化住院次均费用结构,控制医疗费用过快增长,进一步深化公立医院改革,建立合理的医疗费用控制机制提供实证依据。方法收集该院2018-2021年住院患者费用数据,采用结构变动值、结构变动度和结构贡献率等指标进行评价。结果该院患者住院次均费用呈现逐年增长趋势,年均增长率为5.10%,西药类、诊断类、综合医疗服务类、耗材类、治疗类在住院费用构成中所占比重较高;治疗类、耗材类、西药类3个项目的结构变动值较高;其中,治疗类和耗材类对住院次均费用结构变动贡献度较大,两项累积贡献率达52.37%。结论城市公立医院改革的相关控费举措取得一定的成效,但未达到理想效果,西药类和耗材类占比仍旧偏高,而体现医疗服务技术劳务价值的综合医疗服务类项目和治疗类项目占比较低,费用结构有待调整和优化,提示该院应深入推进药品和卫生材料零加成及带量采购政策,合理降低药品和材料费用,进一步达到改革预期。

Objective To analyze the degree of structure variation of the average hospitalization expenses,and to provide empirical evidence for optimizing the structure of the average hospitalization expenses,controlling the excessive growth of medical costs,further deepening the reform of public hospitals,and establishing a reasonable medical cost control mechanism.Methods The data of hospitalization expenses in the hospital from 2018 to 2021 were collected and evaluated by value of structure variation,degree of structure variation,and contribution rate of structure variation.Results The average hospitalization expenses in the hospital showed an increasing trend year by year,with an average annual growth rate of 5.10.Western medicine,diagnosis,comprehensive medical services,consumables and treatment accounted for a high proportion in the composition of inpatient costs.The value of structure variation of the three items of treatment,consumables and Western medicine were high.Among them,the treatment category and consumables category with higher contribution rate of structure variation of average hospitalization cost structure,and the contribution rate of structure variation of the two items was 52.37%.Conclusion The relevant cost control measures of urban public hospital reform have achieved certain results,but have not achieved the desired results.The proportion of western medicine and consumables is still high,while the proportion of comprehensive medical service projects and treatment projects reflecting the value of medical service technology and labor services is relatively low,and the cost structure needs to be adjusted and optimized.It is suggested that the hospital should further promote the policy of zero addition and volume procurement of drugs and health materials,reasonably reduce the cost of drugs and materials,and further achieve the reform expectations.