某三级医院肺叶切除术患者住院费用及影响因素分析  

Analysis of Hospitalization Costs and Influencing Factors of Lobectomy Patients in a Tertiary Hospital

作　　者：马冀 张欣[1] 卢欣阳 于迪 罗蓟[1] Ma Ji;Zhang Xin;Lu Xinyang;Yu Di;Luo Ji(Medical Insurance Department of the First Affiliated Hospital of China Medical University,Shenyang110000,Liaoning Province,China;不详)

机构地区：[1]中国医科大学附属第一医院医疗保险工作部,辽宁省沈阳市110000

出　　处：《中国病案》2022年第11期48-51,共4页Chinese Medical Record

摘　　要：目的对肺叶切除术患者住院费用进行分析,找出影响住院费用的因素,为完善医保支付政策提供参考。方法通过收集病案首页信息及结算费用明细的方式对某三甲医院2014年1月1日-2021年6月31日行肺叶切除手术共计9242例患者进行分析,运用单因素方差分析、多元线性回归等方式对分组效果及影响住院费用的因素进行分析。结果占总费用前3的收费类别分别为材料费(45.02%)、药品费(18.68%)、手术治疗费(15.96%)。肺叶切除术患者总费用的首要影响因素为是否腔镜切除(β=-0.626,P<0.001),其次分别为切除部位(β=-0.233,P<0.001)、病理类型(β=0.211,P<0.001)、住院天数(β=0.201,P<0.001)、年龄(β=0.066,P<0.001)。按项目付费方式下,例均费用63683.14元,人均盈亏0元;单病种支付方式下,例均费用57971.18元,人均盈亏-12811.23元;DRGs支付方式下,例均费用65664.62元,人均盈亏3551.33元。结论腔镜切除是影响肺叶切除术患者住院费用最重要的影响因素,建议未来制定支付政策时应结合临床治疗特点及影响费用消耗的因素,同时尽快实现直线切割吻合器等带量采购,减轻患者就医负担。Objectives This study aims to analyze the hospitalization costs of patients with lobectomy and find out the influencing factors of hospitalization cost in order to provide a reference for improving the insurance payment policy.Methods A total of 9242 patients who underwent lobectomy from January 1,2014 to June 31,2021 in a tertiary hospital were analyzed by collecting the information on the front page of medical records and the details of settlement fees.One-way ANOVA,multiple linear regression,and other methods were used to analyze the effect of grouping and factors affecting hospitalization costs.Results The top three categories of lobectomy expenses were materials(45.02%),medicines(18.68%)and surgical treatment(15.96%).The primary factor influencing the total cost of lobectomies was whether endoscopic resection was performed(β=-0.626,P<0.001),followed by resection site(β=-0.233,P<0.001),pathological type(β=0.211,P<0.001),length of stay(β=0.201,P<0.001)and age(β=0.066,P<0.001).Under the project-based payment method,the average cost is 63,683.14yuan,and the per capita profit and loss is 0 yuan.Under the single-disease payment method,the average cost is 57,971.18 yuan,and the per capita profit and loss is-12,811.23 yuan.Under the DRGs payment method,the average fee is 65,664.62 yuan,and the per capita profit and loss is 3,551.33 yuan.Conclusions Endoscopic resection is the most important factor affecting the hospitalization cost of lobectomy patients.It is suggested that when formulating payment policies in the future,the characteristics of clinical treatment and the factors affecting cost consumption should be combined.At the same time,the procurement of linear cutting staplers and other large-scale purchases should be realized as soon as possible to reduce the burden of medical treatment for patients.

关 键 词：住院费用 影响因素 支付政策 

分 类 号：R197.32[医药卫生—卫生事业管理]