空间视角下的人均住院费用影响因素研究  

Researches on the Factors to Influence the Per Capita Hospitalization Expenses Based on the Spatial Perspective

作　　者：明星宇 杨练[2] 孙群[3] 王美先 黄诗尧 李奕辰 Ming Xingyu(Sichuan Academy of Medical Sciences&Sichuan Provincial People's Hospital,Chengdu,P.R.China.)

机构地区：[1]四川省医学科学院·四川省人民医院病案统计科,四川成都610031 [2]成都中医药大学公共卫生学院 [3]成都中医药大学管理学院 [4]四川大学华西第二医院中国出生缺陷监测中心 [5]国家药监局海南真实世界数据研究与评价重点实验室 [6]四川大学华西第二医院规划财务部

出　　处：《中国卫生事业管理》2022年第11期819-822,839,共5页Chinese Health Service Management

基　　金：四川省科技厅基金“基于空间计量模型的四川省卫生总费用时空演变特征及影响因素研究”(2019JDR0108)。

摘　　要：目的 研究人均住院费用的空间分布情况及其影响因素,为精准决策提供重要参考.方法 通过Global Moran's I和热点分析探索人均住院费用数据的空间相关性和集聚模式,利用地理加权回归模型代替传统最小二乘法模型揭示各影响因素与医疗费用之间的复杂关系.结果 四川省2019年183个县(区、市)的人均住院费用呈现出很强的空间相关性,将空间效应考虑进来的地理加权回归模型解释能力比传统模型提高了 4个百分点,每千人口执业(助理)医师数、三级医疗机构占比、平均住院天数、城镇化率、公路里程、PM2.5浓度共解释了 82%的空间分异.结论 四川省人均住院费用存在强烈的地域差异,同一因素对不同地区造成的影响往往有很大差异,考虑空间效应的微观尺度分析能得到全局模型所忽略的额外信息,有利于深入理解每个因素对人均住院费用的影响机理和空间模式.Objective To study the spatial distribution of per capita hospitalization expenses and its influencing factors,so as to provide important reference for accurate decision making.Methods Methods of Global Morans I and hot spot analysis were used to explore the spatial correlation and clustering model of per capita hospitalization expenses data,and the geographical weighted re-gression model was used instead of the traditional least square model to reveal the complex relationship among various influencing factors and medical expenses.Results In 2019,the per capita hospitalization expenses of 183 counties in Sichuan Province showed a strong spatial correlation.Compared with the traditional model,the interpretation ability of the geographically weighted regres-sion model considering spatial effects increased by 4 percentage points.The number of practicing(assistant)doctors per thousand population,proportion of tertiary medical institutions,average hospitalization days,urbanization rate,highway mileage and PM2.5 concentration explained 82%of the spatial differences.Conclusion There are strong regional differences in per capita hospitaliza-tion expenses in Sichuan Province.And the influence of the same factor on different regions is often very different.Micro-scale analysis considering spatial effect can obtain additional information ignored by the global model,which is conducive to a deep un-derstanding of the influence mechanism and spatial model of each factor on per capita hospitalization expenses.

关 键 词：人均住院费用 GWR 空间分异 空间相关性 影响因素 

分 类 号：R195[医药卫生—卫生统计学]