贵州省某三甲医院肺癌手术患者医疗费用影响因素分析  

Influencing factors of medical expenses of lung cancer patients in a general hospital in Guizhou

作　　者：廖贵曲 黄娟娟 张程[2] 张湘燕[2] LIAO Guiqu;HUANG Juanjuan;ZHANG Cheng;ZHANG Xiangyan(Guizhou University Medical School,Guiyang 550025,China;不详)

机构地区：[1]贵州大学医学院,贵州贵阳550025 [2]贵州省人民医院,贵州贵阳550002

出　　处：《现代医院》2021年第5期746-749,753,共5页Modern Hospitals

基　　金：国家科技支撑计划课题(2013BAI09B09)。

摘　　要：目的探究贵州省肺癌手术患者医疗费用影响因素,为控制医疗费用增长、减轻患者疾病负担提供实践依据。方法收集贵州省2012—2018年出院肺癌手术患者病案首页信息,采用多元线性回归拟合通径模型对其医疗费用影响因素进行分析。结果肺癌手术患者的例均住院时间为15.27 d(中位数为12.00 d),医疗费用为36149.03元(中位数为15113.05元)。药品费用、住院时间和手术等级是医疗费用的最主要影响因素,其他因素包括医保类型、术前等待天数、自付比例、临床路径完成情况、出院时间、诊疗情况、入院途径、出院后是否再入院、性别和年龄,并且通过住院时间和药品费用间接影响医疗费用。结论通过规范诊疗行为、加强药物监管、缩短住院时间、规范临床路径,医疗机构、患者与医疗保险机构多方协同配合,才能有效控制医疗费用上涨、减轻患者疾病负担。Objective To explore the influencing factors of medical expense of lung cancer patients treated with surgical operations in Guizhou, so as to provide practical basis for controlling the increase of medical expense and reducing the burden of patients.Methods The clinical data on the front page of the medical records of lung cancer patients who underwent surgical operations in the hospitals in Guizhou during 2017 to 2018 were collected and analyzed to look into the influencing factors by using the multivariate linear regression.Results The average length of stay per patient was 15.27 days, with a median of 12.00 days, and the average medical expense was 36 149.03 yuan per case, with a median of 15 113.05 yuan. Drug expenses, length of stay and the grade of surgery were the uppermost influencing factors for the expenses, and other factors including the type of medical insurance, waiting days before surgery, the self-pay ratio out of the medical insurance, the completion of the clinical pathway, the discharge time, the diagnosis and treatment, readmission after discharge, gender and age. Additionally, what directly affected the medical expenses were the length of stay and the drug expenses.Conclusion We can effectively control the increase of medical expense and reduce the burden of patients by standardizing medical treatment behaviors, strengthening drug supervision, shortening the length of stay and standardizing the clinical pathway when medical institutions, patients and medical insurance institutions cooperate with each other.

关 键 词：肺癌 手术患者 医疗费用 影响因素 通径分析 

分 类 号：R197.323[医药卫生—卫生事业管理] R734.2[医药卫生—公共卫生与预防医学]