某三甲医院食管癌患者住院费用及影响因素分析

Analysis of hospitalization cost and factors influencing esophageal cancer patients in a Grade Ⅲ Level A hospital

目的:分析某三甲医院食管癌患者住院费用内部构成、变化趋势及影响因素,为公立医院合理控制医疗费用、优化卫生资源配置、分析落实医改政策成效、提升住院患者满意度提供参考。方法:基于临沂市某大型三甲医院病案首页数据,筛选2016-2021年食管癌患者人口学特征、诊疗操作和住院费用明细信息,采用结构变动度、灰色关联分析、单因素分析和多元逐步回归分析等统计方法对食管癌患者住院费用情况和变化趋势进行分析。结果:患者以男性和60岁以上人群为主,平均住院天数11天,手术患者居多;住院费用逐年减少,耗材费与西药费占比最多且关联度最高;医改后西药费与耗材费分阶段占比减少,护理费、手术费、检查费占比正向变动;年龄、实际住院天数和是否手术是影响住院费用的因素。结论:临沂市两轮医改落地已有成效;西药费和耗材费均减少,但卫生服务价格体系仍有优化空间。应强化医院临床路径管理、合理用药与医师规范化诊疗水平,推行复合式医保支付方式,进一步减轻患者经济负担。

Objective:To analyze the internal composition,changing trends,and influencing factors of inpatient costs of esophageal cancer patients in a Grade Ⅲ Level A hospital,so as to provide a reference for public hospitals to reasonably control medical costs,optimize health resource allocation,analyze the effectiveness of implementing medical reform policies and improve inpatient satisfaction.Methods:Based on the case home data of a large Grade Ⅲ Level A hospital in Linyi,the demographic characteristics,treatment operations,and hospitalization cost details of esophageal cancer patients from 2016-2021 were screened,and statistical methods such as structural change degree,gray correlation analysis,univariate analysis,and multiple stepwise regression analysis were used to analyze the hospitalization cost situation and change trends of esophageal cancer patients.Results:The Patients were mostly men and old people aged 60 with a hospital length of stay of 11 days,and most patients had an operation;the hospitalization expenses decreased year by year,the consumable fee and western medicine fee accounted for the largest proportion and showed the highest correlation,the proportions of western medicine fee and consumable fee decreased in phases after two rounds of medical reform,and the proportions of nursing fee,operation fee,and examination fee showed a trend of positive change;age,actual hospital length of stay and operation were factors influencing hospitalization expenses.Conclusion:The two rounds of medical reform in Linyi City have made some achievements,and both western medicine fees and consumable fees led to a decrease in hospitalization expenses,but the health service price system still needs to be optimized further.We should strengthen the clinical pathway management of hospitals,rational drug use,and physicians’standard diagnosis and treatment level,implement composite payment methods with medical insurance,and reduce the financial burden on patients.