| 引用本文：解龙, 汪和平, 周灵利, 钟笑笑, 丁宏.按病种付费下安徽省冠心病患者住院费用构成及影响因素分析[J].中国卫生政策研究,2018,11(5):70-73 |
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| 按病种付费下安徽省冠心病患者住院费用构成及影响因素分析 |
| 投稿时间：2017-06-15 修订日期：2017-11-09 PDF全文浏览 HTML全文浏览 |
| 解龙1, 汪和平2, 周灵利1, 钟笑笑1, 丁宏1 |
1. 安徽医科大学卫生管理学院 安徽合肥 230032;
2. 安徽省农村合作医疗管理办公室 安徽合肥 230032 |
| 摘要:目的：分析安徽省新农合按病种付费下的冠心病患者住院费用结构及其影响因素。方法：通过安徽省农村合作医疗管理中心信息系统，随机在皖北、皖中、皖南各抽取3县，共计9个县，获取2012年1月—2015年9月实施按病种付费的全部冠心病患者住院费用清单共计3 365例，采用描述性统计、结构变动度和多元线性回归进行分析。结果：按病种付费下的冠心病住院患者次均住院费用总体呈下降趋势，皖北总体波动下降、皖南逐年递减、皖中波动上升；药品费和材料费是住院费用的主要构成；影响患者住院费用的主要因素是就诊层次、住院天数、是否手术、地区和年份等。结论：实施按病种付费可有效控制次均住院费用增长；政策实施要关注地区差异，促进区域内均衡发展；控制医疗费用增长，应着重控制药品费和材料费的占比；同时应努力促进医疗联合体的构建和分级诊疗的实施、合理缩短医院平均住院日、控制手术指征等，从而更好地控制医疗费用。 |
| 关键词:按病种付费 冠心病 住院费用 |
| 基金项目:安徽省社会办医模式研究（2015FACJ2755） |
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| Analysis on the composition and influencing factors of coronary heart disease patients' hospitalization expenses under DRGs in Anhui Province |
| XIE Long1, WANG He-ping2, ZHOU Ling-li1, ZHONG Xiao-xiao1, DING Hong1 |
1. School of Public Health Management, Anhui Medical University, Hefei Anhui 230032, China;
2. Anhui Province Rural Cooperative Medical Management Office, Hefei Anhui 230032, China |
| Abstract:Objective:To analyze the structure and influencing factors of coronary heart disease (CHD) patients' hospitalization expenses under DRGs in Anhui Province, so as to provide evidence for rational control of medical costs and improvement of DRGs payment system. Methods:Pursuant to the Anhui Rural Cooperative Medical Center's Information System, three counties were randomly selected from Northern, Central and Southern Anhui. From January 2012 to September 2015, the full payouts for DRGs were analyzed for a total of 3365 cases of coronary heart disease (CHD) patients' hospitalization expenses under DRGs. The trend and composition of aforementioned expenses were analyzed using the methods of descriptive statistics and structural variability analysis. Multiple linear regression analysis was also used to analyze the influencing factors thereof. Results:The average hospitalization cost of coronary heart disease in-patients generally showed a decreasing trend, overall fluctuations in the Northern, Central and Southern Anhui decreased yearly. Results show that hospitalization expenses were mainly composed of drug and material costs. The main influencing factors incurred thereof were found to be the level of hospital, length of hospital stay, whether surgery, region and year. Conclusions:The implementation of DRGs can effectively control the increase in average hospitalization cost, and the coronary heart disease of DRGs hospitalization expenses differ with respect to the region. Therefore, it is suggested that policy implementation should pay attention to regional differences and promote balanced development in the regions under consideration. For an accurate control of the increase in medical expenses, we should put emphasis on the control of drug and material costs, gradually or even completely eliminate drug additions, and improve and optimize the medical cost structure. Meanwhile, efforts should be made to promote the construction of medical consortium and implementation of grading diagnosis and treatment, reasonably shorten the length of hospital stay, and control of surgical indications, which is an equivalent to better control medical expenses. |
| Key words:DRGs Coronary heart disease (CHD) Hospitalization expenses |
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