基于湖北省医保数据库对恶性肿瘤患者全治疗周期医疗资源利用分析  

Utilization of medical resources in patients with malignant tumors during the whole treatment period:based on the medical insurance database in Hubei province

作　　者：刘跃华 杜天天 戴伟 LIU Yue-hua;DU Tian-tian;DAI Wei(China National Health Development Research Center,Beijing 100191,P.R.China;National Center for Drug and Technology Assessment,Beijing 100191,P.R.China;Insitute for Hospital Management,Tsinghua University,Shenzhen 518000,P.R.China;Medical Security Service Center,Hubei Medical Insurance Administration Bureau,Wuhan 430070,P.R.China)

机构地区：[1]国家卫生健康委卫生发展研究中心,北京100191 [2]国家卫生健康委国家药物与卫生技术评估中心,北京100191 [3]清华大学医院管理研究院,广东深圳518000 [4]湖北省医疗保险管理局医疗保障服务中心,湖北武汉430070

出　　处：《中华肿瘤防治杂志》2020年第10期821-826,共6页Chinese Journal of Cancer Prevention and Treatment

基　　金：2019年国家自然科学基金青年项目(71804032)。

摘　　要：目的恶性肿瘤已成为我国主要的公共卫生问题。姑息治疗可以提高医疗资源利用效率和临终期患者的生存质量。因此本研究分析恶性肿瘤患者全治疗周期的医疗资源消耗情况,以及各等级医院在恶性肿瘤终末期患者中的资源利用效率,以期探讨临终期患者的最优治疗选择,为相关方提供决策依据。方法基于湖北省2007-2014年2536例肺恶性肿瘤临床治疗医疗保险支付数据,回顾统计分析肺恶性肿瘤患者全治疗周期的资源利用状况,以及肺恶性肿瘤患者终末期在各等级医院的利用资源情况。结果随着患者年龄增加,年治疗费用呈下降趋势,差异有统计学意义,P<0.001。<50岁患者全治疗周期人均住院费用为19.3万元,而≥70岁患者仅为8~9万元。临终前6个月花费的医疗费用占总费用66.1%。三级医院在总治疗费用支出中占95.3%,次均住院费用为(14200±17030)元。结论人口老龄化不是推高医疗费用上涨的唯一因素,疾病治疗各阶段目标不明确、医疗资源配置颠倒也是助推医疗资源上涨的重要因素,通过改革医保支付方式、加强基层医疗机构能力建设和医院管理,发展适合我国的姑息治疗模式。OBJECTIVE Malignant tumor is becoming a main public health problem in China.Palliative treatment can improve the efficiency of medical resource utilization and the quality of life of patients at the terminal stage.In order to explore the optimal treatment decision for patients and provide reference for relevant decision makers,this study analyzed the consumption status of medical resources in patients with cancer during the whole treatment period,and the current medical resources utilization efficiency in different levels of hospital for end-stage cancer patients.METHODS This study was based on the clinical treatment and payment data of 2536 cases of patients with lung cancer from 2007 to 2014 in Hubei province.We retrospectively analyzed patients’utilization status of different medical resources during their whole treatment period as well as the end stage.RESULTS It was found that with the increase of patients’age,the hospitalization cost decreased and the difference was statistically significant(P<0.001).The per capita hospitalization cost of patients<50 years old was 193000 yuan,while that of the patients≥70 were only 80000-90000 yuan.The medical expenses spent during the last 6 months before dying accounted for 66.1%of the total expenses.The medical expenses which happened in the tertiary hospitals accounted for 95.3%of the total cost,and the average expenses were 14200±17030 yuan per hospitalization visit.CONCLUSIONS Population aging is not the only factor that leads to the rise of medical expenses.The unclear objectives of treatment and the reverse of medical resources allocation are also important factors to boost the growth of medical expenses.It is necessary to improve the payment system of healthcare insurance,strengthen the capacity of primary medical institutions and management,and develop the palliative care system in China.

关 键 词：肺癌 全治疗周期 姑息治疗 临终阶段 人口老龄化 

分 类 号：R730[医药卫生—肿瘤]