慢性阻塞性肺疾病患者住院费用影响因素递归系统与结构方程模型分析  

Analysis of influencing factors of hospitalization expenses of patients with chronic obstructive pulmonary disease based on recursive system model and structural equation model

作　　者：单侯乾 郁娟[1] 韩雪梅[1] 陈雅静 左丽倩 韩雪 SHAN Hou-qian, YU Juan, HAN Xue-mei, CHEN Ya-jing, ZUO Li-qian, HAN Xue(College of Public Health, Lanzhou University, Lanzhou 730000, P. R. China)

机构地区：[1]兰州大学公共卫生学院,甘肃兰州730000

出　　处：《社区医学杂志》2018年第14期1138-1145,共8页Journal Of Community Medicine

摘　　要：目的慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)给患者带来沉重的经济负担,已成为全球面临的重大公共卫生问题。预计至2020年COPD将成为全球第3位致死原因。中国每年因COPD死亡的人数128万。本研究通过对甘肃省兰州市2013-2016年COPD患者住院费用进行分析,对患者住院费用增长主要因素进行定量评价,为相关部门优化卫生费用结构、建立更加完善的卫生资源控制机制提供依据。方法将数据经过预处理后使用递归模型与结构方程模型方法对数据进行分析。结果通过递归系统模型(recursive system model,RSM)最后得出医院等级对于住院费用影响总效应为0.568。在递归系统模型中医院等级影响综合医疗服务费、诊断费与药费总效应分别为0.247、0.587与0.532,医院等级均排在各分析方法影响因素的首位。在递归方程模型中是否手术和入院途径影响因素的总效应分别0.208和-0.075。结构系统模型中(structural equation model,SEM)是否手术影响各部分住院费用的总效应仍然排在前列,其影响综合服务费、诊断费和药费的总效应分别为-0.133、-0.128和0.025 6。入院途径对综合医疗服务费与诊断费的总影响效应分别为-0.324和0.120。结论影响COPD患者住院费用的最主要因素为医院等级、是否手术与入院途径,同时住院天数与职业对住院总费用也产生一定影响。OBJECTIVE Chronic obstructive pulmonary disease（COPD）imposes a heavy economic burden on patients and has become a major public health problem facing the world.Chronic obstructive pulmonary disease is expected to be the third leading cause of death worldwide by 2020.The number of deaths due to COPD in China is 1.28 million per year.In this paper,hospitalization expenses of patients with COPD were analyzede in Lanzhou city,Gansu Province from2013 to 2016.The main factors of patient hospitalization cost increase were quantitatively evaluated in order to provide a basis for relevant departments to optimize health expenditure structure and establish a more perfect control mechanism of health resource.METHODS After preprocessed,the data were analyzed by the recursive model and the structural equation modeling.RESULTS Through the recursive system model（RSM）,the total effect of hospital level on hospitalization expenses was 0.568.In the recursive system model,the total effect of hospital service level,comprehensive medical service fee,diagnosis fee and drug cost was 0.247,0.587 and 0.532,the hospital ranks ranked first in the influencing factors of each analysis method.In the recursive equation model,the total effect of the factors affecting surgery and admission pathway were 0.208 and-0.075,respectively.The total effect of whether the surgical system model（SEM）affects the cost of hospitalization in all parts of the system is still in the forefront.The total effects of the impact on comprehensive service fees,diagnostic fees and drug costs are-0.133,-0.128 and 0.025 6,respectively.The total effect of admission to the combined medical service fee and diagnostic fee was-0.324 and 0.120,respectively.CONCLUSION The most important factors affecting the hospitalization expenses of COPD patients are hospital grade,whether surgery and admission,and the number of hospital stays and occupations have a certain impact on the total hospitalization expenses.

关 键 词：慢性阻塞性肺疾病 住院费用 递归系统模型 结构方程模型 

分 类 号：R563.9[医药卫生—呼吸系统]