摘要
目的了解农村重大疾病流行特征及其住院医疗费用情况,为重大疾病防治及医保政策制定及调整提供参考依据。方法收集陕西省榆林市2015年1月1日-2016年12月31日参加新农合农民的重大疾病数据,描述并比较各类重大疾病流行特征分布及其住院费用情况。结果榆林市2015年1月1日-2016年12月31日登记的9847例次参加新农合农民重大疾病住院患者中,男性5479例次,女性4368例次;重大疾病患者在45~59岁年龄组比例最高(39.2%),其次为≥60岁年龄组(33.2%);女性重大疾病构成随年龄增加呈上升趋势(χ^2趋势=5.165,P=0.023)。居于重大疾病前3位的疾病依次为肿瘤(3278例次)、循环系统疾病(1813例次)、肌肉骨骼系统和结缔组织疾病(847例次)。精神和行为障碍患者平均住院时间最长,为30(12~66)d,平均住院费用最高,为9.9(6.5~18.3)万元,肿瘤患者日均住院费用最高,为0.8(0.4~1.8)万元。女性循环系统疾病及肌肉骨骼系统和结缔组织疾病患者平均住院费用分别为9.7(7.3~13.3)万元和8.5(6.8~10.5)万元,均高于男性患者的8.8(6.8~12.6)万元和7.8(6.4~9.6)万元(均P<0.01);女性先天畸形、变形和染色体异常及损伤、中毒和外因的某些其他后果患者平均住院费用分别为7.1(5.9~8.8)万元和8.0(6.4~10.8)万元,均低于男性患者的8.5(6.5~10.5)和9.3(7.2~13.2)万元(均P<0.01)。不同年龄组比较,某些传染病和寄生虫病、神经系统疾病、呼吸系统疾病及皮肤和皮下组织疾病患者平均住院费用均随年龄增加呈上升趋势(均P<0.05)。结论榆林市农村重大疾病患者整体相对年轻,分性别年龄构成趋势存在差异,应加强重大疾病早期精准防治及医疗救助,重点关注患病较多和住院费用高的重大疾病。
Objective To examine major disease-related hospitalizations and their expenses among rural residents covered by New Rural Cooperative Medical Scheme(NRCMS)and to provide evidences for prevention of major diseases and adjustment of medical insurance policies in rural populations.Methods The data of the study were extracted from the settlement system of NRCMS and health insurance system of Yulin city,Shaanxi province.Information on all NRCMS-reimbursed hospitalizations with a total of more than 30000 yuan RMB out-of-pocket expense during the period from January 1,2015 to December 31,2016 were collected and analyzed.International Classification of Diseases-10th Revision(ICD-10)was adopted to categorize major diseases contributed to the hospitalizations.Results The total number of major disease-related hospitalizations with reimbursement of NRCMS was 9847(5479 and 4368 for male and female inpatients)during the 2 year period in Yulin municipality.Of all the inpatients hospitalized,39.2%and 33.2%were aged 45–59 years and 60 years and above.The proportions of hospitalized female inpatients increased with the increment of age(χtrend^2=5.165,P=0.023).For all the hospitalizations,the top three major diseases were tumor(3278 person-times),circulatory system disease(1813),and musculoskeletal system and connective tissue diseasen(847);both the longest hospital stay(median[M]=30 days,interquartile range[IRQ]:12–66 days)and highest hospitalization expense(M=99000 yuan[RMB],IRQ:65000–183000 yuan)were for those due to mental and behavioral disorders;the highest daily hospitalization expense(M=8000,IRQ:4000–18000)was for tumor-related hospitalizations.For the hospitalizations due to circulatory system diseases and musculoskeletal system/connective tissue diseases,the average expenses(M=97000,IRQ:73000–133000 and M=85000,IRQ:68000–105000)of the female inpatients were significantly higher than those(M=88000,IRQ:68000–126000 and M=785000,IRQ:64000–96000)of the male inpatients(both P<0.01);while,for hospitalizations due to congenital malformations/deformations/chromosomal abnormalities and injury/poisoning/external causes,the average expenses(M=71000,IRQ:59000–88000 and M=80000,IRQ:64000–108000)of the female inpatients were significantly lower than those(M=85000,IRQ:65000–105000 and M=93000,IRQ:72000–132000)of the male inpatients(both P<0.01).For the hospitalizations due to infectious and parasitic diseases,nervous system diseases,respiratory diseases and skin/subcutaneous diseases,the average hospital expenses of the inpatients rose with the increment of age(all P<0.05).Conclusion In rural Yulin of Shaanxi province,the patients of NRCMS-reimbursed hospitalizations due to major diseases are at a relatively young age and the causes and expenses of the patients′hospitalizations differ by age and gender.The results of the study should be concerned in the prevention and treatment of the major diseases among rural residents.
作者
陈红光
王廷伟
韩晶
王廷军
朱红霞
高湘绮
CHEN Hong-guang;WANG Ting-wei;HAN Jing(Sixth Hospital/Institute of Mental Health,Peking University,Beijing 100191,China)
出处
《中国公共卫生》
CAS
CSCD
北大核心
2020年第1期115-119,共5页
Chinese Journal of Public Health
关键词
重大疾病
流行特征
住院医疗费用
医疗保险
major diseases
prevalence characteristics
hospitalization expenses
medical insurance
作者简介
陈红光(1980-),男,河北邢台人,助理研究员,博士,研究方向:流行病学;通讯作者:王廷伟,E-mail:wangtingwei88@126.com。
