中国城镇基本医疗保险急性心肌梗死患者住院费用分析  

Analysis of Hospitalization Expenses of Patients With Acute Myocardial Infarction in Basic Medical Insurance of Urban Population

作　　者：杨进刚[1] 杨雪瑶 杨跃进[1] YANG Jin-gang;YANG Xue-yao;YANG Yue-jin(Coronary Heart Disease Center,National Center for Cardiovascular Diseases and Fuwai Hospital,CAMS and PUMC,Beijing（100037）,China)

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院冠心病中心,北京市100037 [2]首都医科大学附属北京安贞医院心内科

出　　处：《中国循环杂志》2018年第11期1094-1097,共4页Chinese Circulation Journal

基　　金：国家"十二五"科技支撑计划课题(2011BAI11B02);国家卫生和计划生育委员会公益性行业专项(201402001);中国医学科学院医学与健康科技创新工程(2016-I2M-1-0099)

摘　　要：目的:分析全国参加基本医疗保险人员急性心肌梗死(AMI)的住院率和次均住院费用。方法:研究数据来源于2010～2014年全国基本医疗保险参保住院患者抽样数据库,每省抽取省会城市、1个地级市和2个县级统筹地区,分别按2010～2014年所享受过参保待遇者的2%、5%和10%抽取调查对象,共2 523 265人次。从中提取患者出院主要诊断ICD-10编码为I21-I22的AMI患者进行分析。结果:在抽样数据库中共有1 347例AMI患者,以2012～2014年的AMI住院患者推算,年AMI住院率为44.2/10万。中位住院费用为3.1(4.2)万元,住院时间9(8)天。省会城市参保人员人均住院费用最高,为4.0万元,地级市为3.0万元,县级城市仅1.5万元(P<0.001)。省会城市和地级市患者接受经皮冠状动脉介入治疗(PCI)的比例明显高于县级城市患者(分别为50.1%、43.2%和14.9%,P<0.001)。PCI治疗患者中位住院费用为5.2万元,明显高于接受溶栓治疗(2.0万元)和保守治疗(1.3万元)的患者,P<0.001。结论:中国省会城市、地级市和县级城市参加基本医疗保险人员AMI住院费用有明显差别,与接受PCI的患者比例差别有关。Objectives： To analyze the rate of hospitalization for acute myocardial infarction（AMI） and the cost of hospitalization for urban residents participating in national basic medical insurance in China.Methods： Of the sample database of inpatients participating in the national basic medical insurance system from 2010 to 2014, 2%, 5% and 10% of the insured persons was selected from provincial cities, one prefecture-level city, and two countylevel coordinating regions of each province, with a total of 2 523 265 person-times. Patients with AMI who were diagnosed with ICD-10 code I21-I22 from the hospital were selected for analysis.Results： A total of 1 347 patients were diagnosed with AMI in the sample database. It was estimated that the annual AMI hospitalization rate was 44.2 per 100 000 according to the hospitalized AMI patients from 2012 to 2014. The median hospitalization cost was 31 000（42 000） RMB and the median length of stay was 9（8） days. The per capita hospitalization cost of provincial insured personnel was the highest（40 000 RMB）, followed by prefecture insured personnel（30 000 RMB）, and the county insured personnel（15 000 RMB, P〈0.001）. The proportion of patients receiving percutaneous coronary intervention（PCI） in provincial and prefecture cities was significantly higher than that of county-level patients（50.1%, 43.2%, and 14.9%, respectively, P〈0.001）. The median hospitalization cost for PCI was 52 000 RMB, which was significantly higher than thrombolytic therapy（20 000 RMB） and conservative treatment（13 000 RMB, P〈0.001）.Conclusions： The cost of AMI hospitalization for patients with basic medical insurance in provincial cities, perfeture and county cities in China is significantly different, and it is related to the large difference in the proportion of patients receiving PCI or not.

关 键 词：急性心肌梗死 住院费用 

分 类 号：R541[医药卫生—心血管疾病]