恶性肿瘤化疗患者住院费用构成及影响因素分析

Analysis on the Construction of Hospitalization Expenditure for Inpatients with Treatments of Chemotherapy of Malignant Tumor and Influencing Factors

目的:分析陕西省大型公立医院项目付费制度下恶性肿瘤化疗患者的住院费用构成及影响因素,为合理控制其医疗费用的过快增长提供参考依据。方法:收集陕西省西安市2012年两所大型公立三级甲等医院的住院病例首页及住院费用情况,其中确诊为恶性肿瘤化疗10 875例,对住院病例的住院费用构成进行描述,采用逐步回归对住院费用的影响因素进行分析。结果:恶性肿瘤化疗患者药费所占比为74.85%,治疗费和化验费所占比例次之,分别为7.99%、5.56%。影响住院费用的主要因素有:住院天数、药费比、医院管理、是否手术、医保付费方式、伴随症、入院情况、性别。结论:医院科室绩效考核时,应提高恶性肿瘤化疗患者的药费比控制线。合理制定医疗服务价格、合理缩短住院天数、有效降低药费比、提高医院管理水平是控制医疗费用过快增长的有效途径。

Objective:To analyze the composition of hospitalization expenditure and the influencing factors under the thefee-for-service payment system in large public hospitals of Shaanxi,so as to provide references for controlling the over-increasedgrowth of medical costs.Methods:Data was collected from the front pages of medical records(FPMR)and hospitalization expendi-tures of the two large tier 3rd hospitals in Xi'an in 2012. There were 10 875 patients with a principal diagnosis of chemotherapy ofmalignant tumor. The composition of hospitalization expenditure in clinical history was described. The influencing factors of hospitaliza-tion expenditure were analyzed by multiple regression model.Results:The medicine costs for patients with malignant tumor account-ed for 74.85%,the treatment fees and laboratory testing fee accounted for 7.99% and 5.56%. The main factor that influenced the hos-pitalization costs were known as:length of hospital stay,proportion of drug fees,hospital management,whether take the operation,health insurance payment,accompanied diseases,hospital admissions and gender.Conclusion:While evaluating the performance ofhospital clinics,it needs to improve the control proportion of medical fees for patients with malignant tumor chemotherapy. Rationallydesigning the prices for medical services,rationally shortening the length of stay,effectively decreasing the ratio for medical expendi-ture and improving the level of hospital management were regarded as the effective method for controlling the over-increased medical expenditure.