中国城市类风湿关节炎患者住院费用及影响因素分析  

Hospitalization Expense of Patients with Rheumatoid Arthritis from Urban Area in China and Its Influential Factors

作　　者：张叶[1] 吴静静[1] 杨莉[1] 

机构地区：[1]北京大学公共卫生学院,北京100191

出　　处：《中国药房》2013年第2期100-102,共3页China Pharmacy

基　　金：国家自然科学基金面上项目资助(No.71273016);教育部人文社会科学研究青年基金项目资助(No.10YJC630332)

摘　　要：目的:评估类风湿关节炎(RA)患者住院费用并预测其影响因素,为卫生政策制订、卫生经费的投入提供依据。方法:采用分层的二阶段抽样法,从中国基本医疗保险数据库2009年的数据中随机抽取RA住院患者349例,运用患者的人口统计学特征、临床诊断和成本的信息进行分析并用多重线性回归预测经济负担的影响因素。结果:349例RA住院患者的平均年龄为(58.9±13.6)岁,其中73.35%为女性。城镇职工和城镇居民的平均住院时间分别为17.9d和15.8d。平均住院费用为8521.5元(中位数为6227.5元,四分位数间距:4068.9～10287.3元),其中药品费用平均为4256.9元(中位数为3467.8元,四分位数间距:1756.3～5219.6元),药品费用占住院费用的比例接近或超过50%。多重线性回归的结果显示,城镇职工的住院费用比城镇居民高24.2%(P<0.05);东部地区患者的住院费用比西部地区的患者高26.5%(P<0.05);就诊于三级医院患者的住院费用比就诊于一级医院的患者高62.3%(P<0.001);一类城市患者的住院费用比二类城市和三类城市的患者分别高74.1%(P<0.001)和53.4%(P<0.001)。结论:RA患者的住院费用很高,其中,最主要的是药品费用。这些费用的主要影响因素是"医保"的类型、地区、医院的等级以及城市的等级。To evaluate the hospitalization costs of patients with rheumatoid arthritis （RA） and to predict the influential factors, and to provide reference for the formulation of health policy and the input of health expenditure. METHODS： 349 RA patients were randomly selected by stratified two-stage sampling from China Basic Health Insurance Database in 2009. The demographic characters of patient, clinical diagnosis and costs were collected and analyzed, and the influential factors were predicted by multiple linear regression. RESULTS： Average age of 349 RA patients was （58.9 ± 13.6）, among which 73.35% were female. The mean length-of-stay was 17.9 days for urban employees and 15.8 days for urban residents. The average hospitalization cost was 8 521.5 yuan （median： 6 227.5 yuan, IQR： 4 068.9-10 287.3 yuan）, and average drug cost was 4 256.9 yuan （median： 3 467.8 yuan, IQR： 1 756.3-5 219.6 yuan）, accounting for near of above 50% of hospitalization expense. The multiple linear regressions showed that hospitalization expense of urban employees was higher than that of urban residents by 24.2% （P〈0.05）; hospitalization expense of patients from eastern region was higher than western region by 26.5% （P〈0.05） ; hospitalization expense of patients treated in three-level hospitals was higher than in primary hospitals by 62.3% （P〈0.001）; hospitalization expense of patients from first-class cities was higher than from second-class cities and third-class cities by 74.1% and 53.4%, respectively （P〈0.001）. CONCLUSION： The hospitalization expense of RA patients is very high. Costs are now driven predominantly by drug cost. Main influential factors are types of health insurance, regions, levels of hospitals and levels of cities.

关 键 词：类风湿关节炎 住院费用 直接医疗成本 影响因素 

分 类 号：R956[医药卫生—药学] R593.22