天津市三级医疗机构脑卒中患者住院费用研究  

The cost of inpatients with stroke in tertiary medical institutes of Tianjin city

作　　者：李兰翠[1] 孙志明[1] 巫嘉陵[1] 陈博年[1] 鲍迪[1] 马骏[2] 

机构地区：[1]天津市环湖医院医保管理办公室,天津300060 [2]天津医科大学公共卫生学院卫生统计学教研室

出　　处：《中国慢性病预防与控制》2015年第6期431-435,共5页Chinese Journal of Prevention and Control of Chronic Diseases

摘　　要：目的探讨天津市参加城镇职工、城乡居民基本医疗保险的脑卒中患者住院费用构成、个人负担率及医保政策对其影响,为保障医疗保险基金的合理使用,控制医疗费用,降低患者的自费率,减轻患者经济负担提供参考依据。方法从天津市参加城镇职工、城乡居民基本医疗保险的住院患者数据库中整群抽取2010年1月1日至2012年12月31日三级医疗机构脑卒中患者146 826例,观察不同年龄、脑卒中亚型、住院日及预后对住院费用的影响,分析住院费用的主要结构;同时选取其中2所医疗机构脑卒中患者,观察不同险种、脑卒中亚型对个人负担率的影响,分析自费部分的主要结构。结果缺血性脑卒中患者127 090例,多于出血性脑卒中患者(19 736例)。老年组缺血性脑卒中69 074例,占47.05%。天津市三级医疗机构脑卒中患者住院日中位数为14 d,住院费用中位数为1.21万元,患者住院日与发生费用呈正相关(r=0.687,P<0.01)。住院费用中药品费114 837.22万元,占49.56%,比例最高。治愈好转组的次均住院费用为1.20万元,死亡组的次均住院费用为1.24万元,高于治愈好转组,差异有统计学意义(Z=-364.75,P=0.001)。天津市2所三级医疗机构脑卒中住院患者的平均个人负担率为49.20%,城镇职工个人负担率为43.35%,城乡居民个人负担率为68.37%。城乡居民自费金额占实际自付的43.62%,城镇职工患者自费金额占实际自付的62.29%;城镇职工政策性自付金额占实际自付的37.71%,城乡居民政策性自付金额占实际自付的56.38%。城镇职工、城乡居民患者自费总额中药品费所占比例分别为27.31%和28.90%,对自费构成影响最大。在脑卒中患者自费构成中,构成比例由大到小依次为药品费、医用材料费、治疗费和检查费。结论三级医疗机构出血性脑卒中患者平均经济负担高于缺血性脑卒中患者;老年组缺血性脑卒中患者经济负担最重。患Objective To explore the cost and personal burden rate of inpatients with stroke and the influence of medical insurance policy in residents with medical insurance of Tianjin and provide the base for reasonable utilizing the medical insurance fund, controlling medical cost, reducing the personal burden rate and decreasing the economic burden for patients. Methods The subjects were 146 826 stroke inpatients with medical insurance in tertiary medical institutes selected from the data of inpatients with basic medical insurance in urban and rural residents during January 1 of 2010 to December 31 of 2012. The influencing of age, stroke sub-types, hospitalization duration and prognosis on hospitalization cost was observed. The main constitutes of hospitalization cost were analyzed. The influencing of different insurance types and stroke sub-types on personal burden rate in stroke inpatients was selected from two medical institutes. The main constitutes at own expense of inpatients were analyzed. Results The number of ischemic stroke patients was 127 090 cases, which were significantly higher than that of hemorrhagic stroke patients （19 736 cases）, 69 074 ischemic stroke patients were senior patients （47.5%）. The median values of hospitalization duration and cost were 14 days and 12 100 Yuan in stroke inpatients of tertiary medical institutes in Tianjin. The hospitalization duration was positively correlated to medical cost （r=0.687, P〈0.01 ）. The prescription charge in hospitalization cost was the highest （114 837.22 Yuan, 49.56%）. Each hospitalization cost in healing group was 12 000 Yuan and each hospi- talization cost in death group was 12 400 Yuan. There was significant difference between two groups （P〈0.01）. The average personal burden rate of inpatients in two medical institutes of Tianjin was 49.20%, the average personal burden rate of urban staff was 43.35%, the average personal burden rate of urban and rural residents was 68.37%. The proportion of own expense of urban and rural residents

关 键 词：脑卒中 医疗保险 费用 个人负担率 

分 类 号：R181.3[医药卫生—流行病学]