恶性肿瘤住院患者直接经济负担影响因素及医疗保障制度研究  

Research on Impact Factors of Malignant Tumor's Direct Economic Burden and Medical Security System

作　　者：王敏[1] 张开金[1] 姜丽[1] 黄新[1] 包思敏 

机构地区：[1]东南大学公共卫生学院,江苏省南京市210009

出　　处：《中国全科医学》2010年第36期4115-4118,共4页Chinese General Practice

基　　金：国家自然科学基金项目(70973018)

摘　　要：目的研究恶性肿瘤住院患者的疾病经济负担及其影响因素,探讨肿瘤患者的医疗保障制度体系的建设,提出合理降低患者经济负担的制度设计。方法运用SPSS 13.0统计软件对恶性肿瘤住院患者的住院费用、住院天数、费用构成、发病个体特征等进行描述性分析;以患者住院费用对数为因变量,以其他影响因素为自变量,分析肿瘤患者住院直接经济负担的影响因素。结果消化系统肿瘤发病率(41.99%)最高,其次是造血系统(18.01%)和呼吸系统(14.26%)肿瘤;肿瘤患者人均住院费用均超万元,拥有医保的恶性肿瘤患者的住院费用、住院天数、药占比等普遍高于自费患者;对于同一肿瘤,在三级甲等医院的治疗费用明显高于在二级甲等医院的治疗费用;对住院费用影响排前5位的因素分别是:住院天数、手术、输血、药占比指数和医院等级。结论应建立以社区卫生服务中心为肿瘤筛查和康复的基础机构、社会医疗保险和肿瘤大病援助为支撑、恶性肿瘤商业保险为补充的肿瘤医疗保障体制,更好地保障患者的健康。Objective To study the direct economic burden of patients with malignant tumor and its impact factors,explore medical security system construction for malignant tumor patients,and present reasonable system design to relieve the economic burden of the patients.Methods SPSS 13.0 was used to analyze descriptively the hospital expense and its constitution,hospital stay,individual characteristics of malignant tumor,etc.Assume logarithm of hospitalization expenditure as the dependent variable（Y） and other factors as variables（X） to analyze the direct economic burden of malignant tumor patients and its impact factors.Results The morbidity of malignancy in digestive system was the highest（41.99%）,and hematopoietic system（18.01%） and respiratory system（14.26%） were in the next place.The average medical expense per morbidity inpatient was at least RMB 10 000.The hospitalization expenditure,hospital stay and proportion of drug costs of insured inpatients were all higher than uninsured patients.Hospital expenditure of the same malignancy in tertiary hospital was significantly higher than second-tier hospitals.The top five impact factors of hospital expenditure were hospital stay,operation,blood transfusion,proportion of drug costs and hospital-grade.Conclusion Medical security of malignant tumor should be established to protect the right of patients and relieve disease burden,which should be based on the system of diseases screening and rehabilitation in Community Health Service Centre and supported by social medical insurance and malignant tumor aid system and supplemented by commercial medical insurance of malignant tumor.

关 键 词：恶性肿瘤 疾病直接经济负担 影响因素 医疗保障制度 

分 类 号：R73[医药卫生—肿瘤]