2型糖尿病门诊费用影响因素分析及病例分组支付方式研究  

Influencing factors of type 2 diabetes outpatient expenses and study on the payment method of case grouping

作　　者：杨芳 冯海欢[1] 李天俊[1] 孙麟[1] YANG Fang;FENG Hai-huan;LI Tian-jun;SUN Lin(Medical Insurance Office,West China Hospital of Sichuan Univerisity,Chengdu,Sichuan 610041,China)

机构地区：[1]四川大学华西医院医保办公室,四川成都610041

出　　处：《现代预防医学》2022年第7期1246-1251,共6页Modern Preventive Medicine

基　　金：成都市科技厅重点研发项目(2020-YF09-00117-GX);四川省科技厅重点研发项目(2021YFS0145)。

摘　　要：目的 分析2017年至2020年2型糖尿病患者门诊医疗费用影响因素,对门诊慢病医保支付方式提出建议。方法 选取2017年至2020年间某三甲医院门诊2型糖尿病定点治疗患者特征数据和费用数据,运用描述性统计分析2型糖尿病患者基本人口学特征和医疗总费用情况,用单因素及分位数回归方法分析当前费用影响因素,并基于决策树CHAID模型提出医保支付建议。结果 2型糖尿病患者门诊医疗费用影响因素包括:年龄(F=10.110,P<0.001)、医保类型(F=29.420,P<0.001)、并发症个数(F=472.090,P<0.001)、是否并发周围神经病变(F=550.890,P<0.001)、是否并发微循环障碍(F=96.690,P<0.001)、是否并发糖尿病肾病(F=23.600,P<0.001),以及是否伴随肥胖(F=50.720,P<0.001)。其中对费用影响最大的因素分别为:并发症个数、伴随肥胖、并发周围神经病变。根据决策树模型分析结果进行病例分组后,不同组别的2型糖尿病患者的门诊医疗费用存在明显差异(F=747.360,P<0.001),针对性地制定医保支付标准将更具合理性。结论 不同个体特征和不同并发症情况的门诊2型糖尿病患者医疗费用不同,为提高医保基金支付效率并保证医疗机构积极性和合理控费,医保经办机构应该将传统的按病种进行整体限额付费的医保支付方式转化为按病例分组的差异性医保支付,并根据医保、医药和医疗政策变化动态调整支付标准。Objective To analyze the cost influencing factors of Type 2 diabetes patients in the outpatient department of a tertiary hospital during 2017—2020, and to advise on the payment method of outpatient chronic disease medical insurance. Methods The characteristic data and cost data of patients with type 2 diabetes designated treatment in a tertiary hospital from 2017 to 2020 were selected, descriptive statistics were used to analyze basic demographic characteristics, total medical expenses, single factor, and quantile regression methods were used to analyze current cost influencing factors, and medical insurance payment recommendations were proposed based on the decision tree CHAID model. Results Influencing factors of outpatient medical expenses for patients with type 2 diabetes included: age(F=10.110, P<0.001), type of medical insurance(F=29.420, P<0.001), number of complications(F=472.090, P<0.001), and whether it is concurrent Peripheral neuropathy(F=550.890, P<0.001), whether it is complicated by microcirculation disorder(F=96.690, P<0.001), whether it is complicated by diabetic nephropathy(F=23.600, P<0.001), and whether it is accompanied by obesity(F=50.720, P<0.001). Among them, the factors that had the greatest impact on costs were the number of complications, obesity, and peripheral neuropathy. After grouping the cases according to the analysis results of the decision tree model, there were significant differences in the outpatient medical expenses of patients with type 2 diabetes in different groups(F=747.360, P<0.001), and it would be more reasonable to formulate medical insurance payment standards in a targeted manner. Conclusion The medical expenses of outpatients with type 2 diabetes with different individual characteristics and different complications are different. To improve the payment efficiency of medical insurance funds and ensure the enthusiasm of medical institutions and reasonable control of expenses, medical insurance agencies should set the traditional overall limit based on disease types

关 键 词：2型糖尿病 门诊医疗费用 影响因素 病例分组支付 

分 类 号：R197.3[医药卫生—卫生事业管理] R587.1[医药卫生—公共卫生与预防医学]