基于“卫生费用核算体系2011”的深圳市可避免住院研究

Analysis on Avoidable Hospitalization in Shenzhen Based on the Health Accounting SHA 2011

目的:核算深圳市可避免住院规模、费用及筹资结构,为提高医疗卫生资源利用效率提供数据支撑。方法:基于“卫生费用核算体系2011”分析深圳市可避免住院现状及其费用的规模结构。结果:2019—2022年,可避免住院患者共441426人次,糖尿病、高血压、心绞痛、流感和肺炎及脱水和肠胃炎,累计占比约达70.00%;可避免住院费用为5250280.60万元,占住院总费用的6.18%,自付费用为176272.44万元,占可避免住院患者总费用的33.57%,心绞痛、坏疽和风湿性心脏病的自付费用较高且自付比例较大。结论:深圳市可避免住院费用规模较大,由于不合理住院造成的医疗资源浪费问题较为严重。应提高初级医疗保健水平,规范医生行为,加大对重点人群疾病的干预作用,优化医保报销体系。

Objective:To estimate the scale,expenditure and financing structure of potentially preventable hospitalization(PPH)for diabetes in Shenzhen,and provide data support for improving the utilization efficiency of medical and health resources.Methods:The System of Health Account 2011 was used to calculate the status of PPH for diabetes in Shenzhen and its cost scale and structure.Results:In 2019—2022,there will be a total of 441426 avoidable hospital admissions for diabetes,hypertension,angina,influenza and pneumonia and dehydration and gastroenteritis,which cumulatively account for approximately 70.00%of admissions.The cost of hospitalization could be avoided by 525028.06 million yuan,accounting for 6.18%of the total costs.The out-of-pocket costs were 1762.7244 million yuan,accounting for 33.57%of the total avoidable hospitalization costs.The out-of-pocket payment of angina pectoris,gangrene and rheumatic heart disease were higher and the proportion of out-of-pocket costs was larger.Conclusion:The large scale of hospital can be avoided in Shenzhen,and the waste of medical resources caused by unreasonable hospitalization is serious.The level of primary health care should be improved,the behavior of doctors should be regulated,the role of intervention in diseases of key populations should be increased,and the system of reimbursement of health insurance should be optimized.