基于卫生费用核算体系2011的甘肃省心脑血管疾病治疗费用核算分析

Analysis of treatment costs of cardio-cerebrovascular diseases in Gansu Province based on a System ofHealth Accounts 2011

目的 探讨甘肃省2019年心脑血管疾病治疗费用及其在不同维度的费用分布情况及影响因素,为心脑血管疾病的防治及合理减轻治疗费用负担提供科学依据。方法 2019年心脑血管疾病治疗费用总量数据来源于《甘肃省2019年卫生健康财务年报》、《甘肃省卫生健康统计年鉴(2020)》、《甘肃发展年鉴-2020》及政府卫生投入监测系统等。采用多阶段分层整群抽样方法抽取甘肃省1 013家医疗卫生机构,建立2019年甘肃省心脑血管疾病个案数据库。以卫生费用核算体系2011(SHA 2011)为基础,采用“自上而下”的分摊方法,用Stata/SE 15.1软件核算2019年甘肃省心脑血管疾病治疗总费用,采用Kruskal-Wallis H检验和Mann-Whitney U检验及多重线性回归分析住院费用的影响因素。结果 2019年甘肃省心脑血管疾病治疗费用为954 723.40万元,占全省疾病治疗费用16.62%。其中72.90%用于住院治疗;男性治疗费用高于女性;60岁及以上治疗费用占61.05%;治疗费用由高到低位居前3位的病种分别为冠心病、原发性高血压和脑梗死;84.42%的治疗费用流向医院,流向基层医疗卫生机构的治疗费用仅占13.45%。多重线性回归分析结果显示,住院天数长(β=0.055)、男性(β=0.064)、年龄高(β=0.006)、手术(β=0.890)的患者住院费用较高,医疗付款方式为城乡居民(β=0.065)、自费(β=0.012)和其他(β=0.069)的患者相对城镇职工患者住院费用较高;而中医院(β=-0.975)、专科医院(β=-1.134)、妇幼保健机构(β=-1.138)和基层医疗卫生机构(β=-1.067)相对综合医院而言,市级机构(β=-0.553)和县(区)级及以下机构(β=-0.927)较省级机构而言,患者住院费用较低,均有统计学意义(P<0.01)。结论 甘肃省心脑血管疾病治疗费用规模大,应从重点病种、重点人群出发进行重点防控,并持续优化分级诊疗制度,提高医疗卫生资源配置效率。

Objective To explore the treatment costs of cardio-cerebrovascular diseases(CVDs)in Gansu Province in 2019,the distribution of costs in different dimensions and the influencing factors,and provide the scientific basis for the prevention and treatment of CVDs and reasonable reducing the burden of treatment costs.Methods The data of total treatment costs for CVDs in 2019 were from"Health Financial Annual Reports in Gansu Province in 2019","Health Statistical Yearbooks in Gansu Province in 2020","Development Yearbook in Gansu Province in 2020"and"government health investment monitor system".The multistage stratified whole-group sampling method was used to extract 1013 medical and health institutions in Gansu Province for establishing a database of CVDs cases in Gansu Province in 2019.Based on a System of Health Accounts 2011(SHA2011),the treatment cost of CVDs in Gansu Province in 2019 was calculated by the top-down allocation method,the used software was Stata/SE 15.1 for check computation.Kruskal-Wallis H test,Mann-Whitney U test and multiple linear regression were used to analyze the influencing factors of hospitalization costs.Results In 2019,the total cost of treatment for CVDs in Gansu Province was 9547.2340 million yuan,which was 16.62%of the total cost of treatment for Gansu Province;72.90%of curative cost was used for inpatient treatment.CVDs treatment cost of male patients was higher than that of female patients;and 61.05%of cost for treating CVDs was used for≥60 years old group.The CVDs order of top three treatment costs was coronary heart disease,primary hypertension and cerebral infarction;84.42%of the cost was used in hospitals,and the cost proportion in basic-level health care institution was only 13.45%.Multiple linear regression results showed that the costs of patients with longer duration of hospitalization(β=0.055),male(β=0.064),higher age(β=0.006),operation(β=0.890)were significantly higher;the costs of patients with urban and rural residents(β=0.065),self-pay(β=0.012),and other(β=0.069)medical payment methods were significantly higher,as compared with the urban employees patients;as compared with general hospitals,the inpatient costs of Chinese medicine hospital (β=-0.975) ,specialized hospitals (β=-1.134),maternal and child health institutions (β=-1.138)and primary health care institutions (β=-1.067 )were significantly lower;and as compared with provincial institutions ,theinpatient costs of municipal institutions (β=-0.553) and ≤county (district) level (β=-0.927) were significantly lower,P<0.01.Conclusion In Gansu Province,the scale of treatment costs of CVDs is large. It should pay attention to the prevention and controlfor key diseases and key populations;and should continue to optimize the graded treatment system and to improve the efficiency ofmedical and health resources allocation.