北京市大型公立医院产妇住院分娩费用分析

Analysis of the cost of hospital delivery for postpartum women in large public hospitals in Beijing

目的分析不同分娩方式、年龄及合并症或并发症的产妇住院分娩费用,为医疗机构及医疗保险管理相关部门制定住院分娩支付与补偿标准提供参考。方法选取北京市8家大型三级甲等医院2018年1月至2021年12月收治的住院分娩产妇病案首页,对产妇的分娩方式、年龄、住院费用和费用结构,以及不同合并症或并发症产妇的住院费用情况进行描述性分析,采用Wilcoxon秩和检验、Kruskal-Wallis H检验、χ2检验对组间水平与结构差异进行统计学比较。结果共纳入产妇23320例,平均年龄32.3岁,自然分娩和剖宫产分别为13605例和9715例。适龄组(<35岁)和高龄组(35~50岁)产妇的剖宫产率中位数分别36.73%和56.58%,住院费用中位数分别为5865元和7042元;自然分娩和剖宫产住院费用中位数分别为4452元和10033元。自然分娩和剖宫产住院费用中占比最高的项目分别为治疗费(23.45%)和药品费(29.19%)。伴随≥2种合并症或并发症产妇的住院费用中位数(6736元)高于有1种合并症或并发症产妇(5794元)。结论剖宫产住院费用高于自然分娩费用,35岁及以上产妇剖宫产率及分娩住院费用均高于35岁以下产妇,不同分娩方式的住院费用结构不同,合并症或并发症对住院费用影响较大。

Objective To analyze the hospitalization costs of delivery for postpartum women with different delivery methods,ages and comorbidities or complications,for references for medical institutions and medical insurance management departments to develop payment and compensation standards for inpatient delivery.Methods The first page of medical records of hospitalized delivery women admitted to 8 large tertiary hospitals in Beijing from January 2018 to December 2021 were selected.Descriptive analysis was made on the mode of delivery,age,hospitalization expenses and cost structure of puerpera,as well as the hospitalization expenses of puerpera with different complications or complications.Wilcoxon rank sum test,Kruskal-Wallis H test,and Chi-squared test were used to statistically compare the level and structure differences between groups.Results A total of 23320 pregnant women were included,with an average age of 32.3 years.There were 13605 cases of natural delivery and 9715 cases of caesarean section.The median cesarean section rate in the right age group(<35 years old)and the elderly group(35-50 years old)were 36.73%and 56.58%,respectively,and the median hospital expenses were 5865 yuan and 7042 yuan,respectively.The median hospital expenses for natural delivery and caesarean section were 4452 yuan and 10033 yuan,respectively.The highest proportion of hospitalization expenses for natural delivery and cesarean section were treatment expenses(23.45%)and medicine expenses(29.19%),respectively.The median of hospitalization cost for women with≥2 comorbidities or complications(6736 yuan)was higher than that for women with 1 comorbidities or complications(5794 yuan).Conclusions The hospitalization cost of cesarean section was significantly higher than that of natural delivery and the rate of cesarean section and the cost of delivery in women aged 35 and above were higher than those under 35 years old.The structure of hospitalization cost was different in different delivery modes,and the complications or complications had a greater impact on the average hospitalization expenses.