2013-2017年安徽省农村胃癌患者住院医疗服务利用及经济负担分析  

Analysis of inpatient medical care use and economic burden of gastric cancer in rural areas of Anhui province from 2013 to 2017

作　　者：柴静[1] 张娟[2] 沈兴蓉 王德斌[1] 贾尚春[3] 胡志[1] CHAI Jing;ZHANG Juan;SHEN Xing-rong;WANG De-bin;JIA Shang-chun;HU Zhi(School of Health Services Management,Anhui Medical University,Hefei 230032,P.R.China;Department of Cancer Prevention,Anhui Provincial Cancer Hospital,Hefei 230031,P.R.China;Department of Chronic Disease Prevention and Control,Anhui Center for Disease Control and Prevention,Hefei 230601,P.R.China)

机构地区：[1]安徽医科大学卫生管理学院,安徽合肥230032 [2]安徽省肿瘤医院防癌科,安徽合肥230031 [3]安徽省疾病预防控制中心慢性病防治科,安徽合肥230601

出　　处：《中华肿瘤防治杂志》2019年第22期1692-1699,共8页Chinese Journal of Cancer Prevention and Treatment

基　　金：国家自然科学基金(71503008);国家重点研发计划(2016YFC1302800;2016YFC0901400)

摘　　要：目的胃癌给患者带来了沉重的经济负担,但中国关于胃癌的经济负担研究较少。本研究通过分析安徽省2013-2017年新农合胃癌患者的报销数据,了解医改背景下胃癌患者住院医疗服务利用及经济负担的变化特征与趋势,为重大疾病保障制度的改革及优化卫生资源配置等提供线索。方法获取2013-2017年安徽省新农合报销系统内各地市所有胃癌患者的报销数据,采用描述性统计方法分析数据。结果共纳入胃癌住院报销73 481人次,男女占分别74.4%和25.6%。就诊医院主要为三级和二级医院,分别占48.6%和40.2%。2013-2017年,安徽农村人口胃癌新农合报销从12.22人次/10万增加到65.2人次/10万,每10万农村人口胃癌患者医疗总费用升高了20.7%;次均住院天数从13.8d下降到9.0d,各地市次均住院天数差异逐年减小。次均住院医疗总费用为12 407元,其中药费占27.2%,材料费、检查费和化验费分别占21.3%、8.0%和4.9%。药费占比从35.1%下降到24.9%。次均医疗总费用占当年人均可支配收入的比重从1.1下降为0.9,次均个人自付费用占当年人均可支配收入的比重从0.5下降为0.3。结论近5年,安徽省胃癌住院费用报销的覆盖面与水平、患者的疾病负担,以及住院服务的流向、过程及费用结构均有了明显的改善,但依然存在较大的地区差异等问题。OBJECTIVE Gastric cancer brings heavy economic burden to patients,but there are few studies on the economic burden of gastric cancer in China.The study aimed to understand the characteristics and trends of inpatient medical expenses and economic burden of gastric cancer patients under the background of medical reform and provide clues for the reform of major disease protection system and the optimization of health resource allocation.METHODS The study obtained the reimbursement data of all gastric cancer in different cities from the new rural cooperative medical information system in Anhui province from 2013 to 2017.Description method was used to analyze the data.RESULTS A total of73 481 inpatients with gastric cancer received the reimbursement.Female and male inpatients made up 74.4%and 25.6%,respectively.Gastric cancer patients mainly chose tertiary hospitals and secondary hospitals,accounting for 48.6% and40.2%,respectively.The number of gastric cancer inpatients in the new rural cooperative medical information system increased from 12.2 to 65.2 per 100 000 rural population from 2013 to 2017.The total medical expenses of gastric cancer patients increased by 20.7% per 100 000 rural population.The average hospitalization days per time decreased from 13.8 to 9.0 and the difference of the average hospitalization days per time decreased year by year.The average hospitalization cost per time was 12 407 yuan,of which 27.2% was for medicine,21.3%for materials,8.0%for inspection and 4.9%for laboratory tests.The proportion of drug expenses decreased from 35.1%in 2013 to 24.9%in 2017.The proportion of total medical expenses per visit in per capita disposable income decreased from 1.1 to 0.9.Per capita personal expenses as a percentage of disposable income fell from 0.5 to 0.3.CONCLUSIONS In the past five years,the coverage and level of reimbursement for gastric cancer hospitalization expenses in Anhui Province have increased significantly.The disease burden of patients has been reduced.The flow direction,process and cost

关 键 词：新农合 胃癌 医疗费用 经济负担 

分 类 号：R73-31[医药卫生—肿瘤] R735.2[医药卫生—临床医学]