摘要
目的:研究某三甲医院“十三五”期间单纯骨折后手术患者住院总费用的变化趋势及其影响因素,探讨医药卫生体制改革相关政策的实施对患者住院费用调控的效果。方法:从某部队三甲医院HIS系统提取2016年1月1日-2020年12月31日出院的骨折后手术患者的基本信息、临床信息和住院费用信息,描述性分析患者住院总费用和关键的六个单项费用(药费、耗材费、检查检验费、手术及麻醉费、诊疗费和护理费)的变化趋势,利用多元线性回归模型探讨分析影响患者住院总费用的影响因素。结果:2016-2020年该院单纯骨折后手术患者住院费用剔除物价上涨因素的影响后,人均住院费用为36735.49元,并随时间变化呈现下降趋势(P<0.001)。重点关注的六个单项费用中,药费呈现持续下降趋势,耗材费、检查检验费、手术及麻醉费和护理费随时间变化均呈现增长趋势(P<0.001),而诊疗费的变化并未呈现固定趋势。多因素回归分析结果提示患者实际住院天数、输血治疗和实施药品带量采购政策增加患者住院总费用,而低福利程度的医保类别和取消药品加成可以降低患者的住院总费用,取消耗材加成和实施检验检查去组合的政策暂未对患者住院费用产生明显影响。结论:“十三五”期间,该部队三甲医院单纯骨折后手术患者住院总费用呈现下降趋势,费用内部结构在一定程度上体现了药费向体现医务人员技术价值的劳务费平移,取消药品和耗材加成、实施药品带量采购等系列医改措施对控制患者住院总费用增长的效果不仅要考虑病种,还要考虑执行时间、执行力度以及配套措施等因素。
Objective:To study the changing trend and influencing factors of the total hospitalization expenses of the fractured with surgery in a certain grade A tertiary hospital during the“Thirteenth Five-Year Plan”Period.To explore the effect of the implementa⁃tion of relevant policies on the reform of the medical and health system on the regulation of patients'hospitalization expenses.Methods:The basic information,clinical information,and hospitalization cost information of the fractured with surgery discharged from the hospital from January 1,2016 to December 31,2020 were extracted from the HIS system of a certain grade A tertiary hospital,conduct⁃ed the descriptive analysis of the change trend of the total hospitalization expenses of patients and six key individual expenses(drug ex⁃penses,consumables expenses,inspection and inspection expenses,surgery and anesthesia expenses,diagnosis and treatment expens⁃es,and nursing expenses),and the multiple linear regression was used to explore and analyze the impact factors influencing the total cost of hospitalization for patients.Results:From 2016 to 2020,after excluding the effect of price increase,the average hospitalization charge of the simple fractured with surgery was 36,735.49 yuan,and the total hospitalization charge showed a downward trend over time(P<0.001).Among the six single costs of focus,the drug costs showed a continuous downward trend,while the consumables costs,in⁃spection and inspection costs,surgery and anesthesia costs,and nursing costs all showed an increasing trend over time(P<0.001),while the changes in diagnosis and treatment costs without fixed trend.The results of multivariate regression analysis showed that the actual hospitalization days,blood transfusion treatment,and the implementation the policy of purchasing medicines with quantity in⁃creased the total hospitalization cost of the patient,while the low welfare type of medical insurance and the implementation of the can⁃cellation of the drug addition policy could reduce the total hospitalization cost of the patient,while the implementation of taking con⁃sumables bonus policy and de-combining policy had not a significant impact.Conclusion:During the“Thirteenth Five-Year Plan”pe⁃riod,the total hospitalization expenses of patients with surgery after simple fractures in the military grade A tertiary hospital showed a downward trend,and the internal structure of expenses reflected the shift of drug expenses to labor expenses reflecting the technical val⁃ue of medical personnel to a certain extent.The effect of a series of medical reform measures such as cancel the drug mark-up and con⁃sumables policy,and the policy of purchasing medicines with quantity on controlling the increase in the total hospitalization cost of pa⁃tients should not only consider the type of disease,but also the implementation time,implementation strength,and supporting measures.
作者
丁敬美
韩磊
DING Jingmei;HAN Lei(Department of Quality Management,General Hospital of Central Theater Command;Medical Management Depart-ment,Wuhan,Hubei,430000)
出处
《江苏卫生事业管理》
2022年第10期1288-1293,1317,共7页
Jiangsu Health System Management
基金
中部战区总医院2021年度育英计划孵化项目(ZZYFH202103)。
关键词
住院费用
费用结构
变化趋势
取消药品加成
取消耗材加成
药品带量采购
Hospitalization Expenses
Expense Structure
Trends
Cancel The Drug Mark-up Policy
Cancel the Consumables Mark-up Policy
The Policy of Purchasing Medicines with Quantity
作者简介
通讯作者:丁敬美,E⁃mail:djm.1989@qq.com。
