脑卒中三级康复方案的卫生经济学研究  

Health economic research on tertiary stroke rehabilitation treatment

作　　者：钮竹[1] 张通[1] 

机构地区：[1]首都医科大学附属康复医学院中国康复研究中心神经康复科,北京100068

出　　处：《中华神经科杂志》2006年第9期595-599,共5页Chinese Journal of Neurology

基　　金：国家"十五"攻关课题基金[2001BA703818(B)]

摘　　要：目的探讨脑卒中康复的卫生经济学问题。方法按照统一的入选和排除标准选取北京地区3家医院神经内科2001年11月至2003年12月住院的脑卒中患者82例为研究对象。在北京市的3家三级甲等医院建立三级医疗-康复体系。在脑卒中发病后1周内、1个月末、3个月末及6个月末,分别评价患者的临床神经功能缺损、肢体运动功能、日常生活活动能力及生活质量,并由专人进行家庭经济情况及费用方面的调查。结果发病后3个月及6个月,康复组的各项功能评分结果明显好于对照组。康复组6个月时 Barthel Index 评分平均达到83.18±18.22,而对照组为63.69±12.73。康复组医疗直接费用、非医疗直接费用、间接费用较对照组低。6个月时康复组的总费用为(56420.0±17831.8)元,对照组的总费用为(64864.2±18267.5)元。康复组在成本/效益比和成本/效用比方面都优于对照组。两组在费用构成比上差异有统计学意义,康复组患者在全部6个月康复过程中所花费的康复治疗费平均为4613元,仅占患者所有费用的15.3%,对照组的药费和辅助设施费均明显高于康复组。结论脑卒中康复不但是有效的,而且具有良好的成本/效益比和成本/效用比。我国脑卒中治疗的费用构成以药费为主,即使是在恢复期,药费占的比例也占整体医疗费用的绝大部分。康复治疗费所占比重很小,这与发达国家相比有很大不同。Objective To economically investigate tertiary stroke rehabilitation treatment. Methods 3 tertiary rehabilitation networks were set up in Beijing. 82 patients with acute cerebrovascular diseases were enrolled into the study according to standardized criteria in all centers and randomized into rehabilitation group and control group. Rehabilitation training was implemented according to standardized procedures. The patients in rehabilitation group were given rehabilitation training in acute stage for 28 days and then underwent long term rehabilitation program for 6 months in rehabilitation centers or community rehabilitation settings. The patients in control group were only given rehabilitation training in acute stage for 28 days. Altogether 4 evaluations were conducted in one week after the onset and at the end of 1, 3, 6 months, respectively. Results Significant differences of motor function, ability of daily activities, quality of life evaluation and cost were found in the 1st, 3rd and 6th month after the onset of diseases. The rehabilitation group surpassed the control group significantly. At the end of 6 months, the average of Barthel Index of rehabilitation group was 83. 18±18. 22 while that of control group was 63.69 ± 12.73. At the end of 6 months, total cost of rehabilitation group was （56 420. 0±17 831.8） Yuan and that of control group was （64 864. 2±18 267. 5） Yuan. The rehabilitation group had better cost/effectiveness and cost/utility. There was a significant difference of cost between two groups. The total rehabilitation cost of rehabilitation group was 4613 Yuan, accounting for 15. 3% of all the cost. Condusion The tertiary rehabilitation treatment for stroke patients has achieved better cost/effectiveness and cost/utility. In China pharmaceutical cost constitutes the major part of the stroke therapy while the rehabilitation cost only a small portion, which is significantly different from the situation in developed countries.

关 键 词：脑血管意外 康复 费用 医疗 

分 类 号：R322[医药卫生—人体解剖和组织胚胎学]