脑缺血性疾病患者住院费用影响因素分析  

Study on Influencing Factors of Hospitalization Expenses of Patients with Cerebral Ischemic Diseases

作　　者：卫安乐 冯文[1] WEI Anle;FENG Wen(School of Public Health,Peking University,Beijing 100191,China;不详)

机构地区：[1]北京大学公共卫生学院,北京100191

出　　处：《卫生经济研究》2023年第12期14-19,共6页

基　　金：国家医保局项目“门诊共济保障机制下的医保基金监管方式研究”;泰康溢彩公共卫生及流行病防治专项基金资助“为健康老年付费——DRG支付方式改革对老人住院服务的影响”(2020〔7〕)。

摘　　要：目的:分析脑缺血性疾病患者的住院费用影响因素,为完善地方DRG分组方案提供依据。方法:利用2019—2020年某地级市医保数据,分析4家三级医院和8家二级医院脑缺血性疾病患者的住院费用,采用多水平模型及多重线性回归分析患者住院费用的影响因素。结果:脑缺血性疾病患者住院费用有11.5%、0.8%和10.7%的变异来自医院级别、三级医院、二级医院之间的差异;医院等级、患者的年龄、性别、合并症或并发症严重程度以及住院时间是住院费用的影响因素。结论:各地应基于DRG“同病同价”政策导向,评估不同级别及同一级别医院之间的费用差异,合理设置机构分层及费率标准;同时考虑患者年龄、疾病严重程度及诊疗模式等因素,制定适合的本土化DRG实施方案。Objective To analyze the hospitalization expenses of patients with cerebral ischemic diseases and related influencing factors,and to provide a reference for improving the local disease diagnosis-related group(DRG)grouping and implementation scheme.Methods Using data from health insurance fund platform in a prefecture-level city from 2019 to 2020,the hospitalization expenses of patients with cerebral ischemic diseases in four tertiary hospitals and eight secondary hospitals were analyzed.Through multi-level models and multiple linear regressions,the influencing factors of patient hospitalization expenses were analyzed.Results The differences between hospital level,tertiary hospital,and secondary hospital accounted for 11.5%,0.8%,and 10.7%of the variance in hospitalization expenses of patients with cerebral ischemic diseases,respectively.Hospital level,patient age,gender,severity of comorbidities or complications,and length of hospital stay were influencing factors of hospitalization expenses.Conclusion Based on the DRG policy of"equal price for the same disease",the localities should assess the hospitalization expenses differences between different levels and hospitals at the same level,reasonably set institutional stratification and payment standards,and develop a suitable localized DRG implementation plan considering factors such as patient age,disease severity,and diagnosis and treatment patterns.

关 键 词：脑缺血性疾病 住院费用 疾病诊断相关分组 多水平模型 

分 类 号：R19[医药卫生—卫生事业管理]