新生儿住院按病种分值付费医保统筹基金结余的影响因素分析

Analysis of Influencing Factors on Balance of Medical Insurance Pooling Fund for Hospitalized Newborn based on Diagnosis-Intervention Packet

目的 分析新生儿住院医保统筹基金结余的影响因素。方法 收集2020年1月1日-11月30日出院的新生儿医保患者共232例,采用Wilcoxon、Kruskal-Wallis秩和检验和Spearman相关分析进行医保统筹基金结余影响因素的单因素分析,采用广义线性模型进行多因素分析。结果 232例患儿涵盖52个病种组,排在前5位的病种为新生儿黄疸(54例)、早产儿(41例)、新生儿肺炎(30例)、新生儿感染(27例)、早产低出生体重(13例)。单因素分析结果显示,病种、偏差病例、住院医师、性别、手术、麻醉对医保统筹基金结余的高低均有影响;相关分析发现,住院天数、医疗费用、出生体重与结余呈负相关;最终多因素分析去除因素间互相影响后显示,黄疸、呼吸疾患和感染医保统筹基金结余较低;偏差病例、男性新生儿结余较低;新生儿出生体重越大,结余越低。结论 结合广义线性模型多因素分析所得的影响因素,应重点管理黄疸、呼吸疾患和感染等数量多且结余较低病种;加强足月、非低出生体重类患儿管理;总结偏差病例临床治疗特点,寻求优化办法。合理增加医保统筹基金结余。

Objectives This study aims to analyze the influencing factors of newborn about balance of medical insurance pooling fund. Methods The information of newborn medical insurance patients discharged from January 1, 2020to November 30, 2020 was collected. Wilcoxon, Kruskal-Wallis rank sum test, and Spearman correlation analysis were used to conduct a univariate analysis of factors affecting balance of medical insurance pooling fund, and a generalized linear model was used to conduct a multivariate analysis. Results 232 newborns with medical insurance containing 52diagnosis interventions were selected. The top five diseases were neonatal jaundice(54 cases), preterm infants(41cases), congenital pneumonia(30 cases), infection(27 cases) and low birth weight(13 cases). In univariate analysis,disease categories, deviation cases, residents, gender, surgery, anesthesia, and related analysis findings that had an impact on the balance of medical insurance pooling fund, along with hospitalization days, medical expenses, and birth weight, which were negatively correlated with balance of medical insurance pooling fund, were included in multivariate analysis as independent variables. After removing the interaction between factors, jaundice, respiratory disease, and infection had lower balance of medical insurance pooling fund. Deviation cases, Male newborns had lower medical insurance balances. Higher birth weight was linked to lower health insurance balances. Conclusions After removing the interaction between factors, Hospitals should focus on the management of jaundice, respiratory diseases, infections, and other diseases with a large number and low balance, strengthen the management of full-term and non-low birth weight newborns, summarize the characteristics of clinical treatment of deviation cases, seek better management methods,reasonably increase the balance of medical insurance, and promote the construction of hospital talents and disciplines.