人工晶体集中带量采购政策下老年性白内障手术患者单病种结算费用及影响因素研究  

Study on the single-disease settlement cost and influencing factors of age-related cataract surgery patients under the centralized volume-based procurement policy of intraocular lens

作　　者：彭勇华 姚卫光 PENG Yong-hua;YAO Wei-guang(Department of Medical Equipment,The First Affiliated Hospital of Jinan University,Guangzhou,Guangdong 510630,China;不详)

机构地区：[1]暨南大学附属第一医院设备科,广东广州510630 [2]南方医科大学卫生管理学院

出　　处：《现代预防医学》2024年第4期674-679,共6页Modern Preventive Medicine

基　　金：广东省高校哲学社会科学重点实验室项目(2015SWSYS0010);广州公共卫生服务体系建设研究基地资助项目(2021-2023)。

摘　　要：目的 对人工晶体集中带量采购政策下的老年性白内障手术患者单病种结算费用及影响因素进行研究,为优化费用结构和控制医疗费用增长以及完善人工晶体材料限额付费政策提供相应的理论建议和数据支撑。方法 收集广州某省属三级甲等公立综合医院眼科2021年6月1日至2022年4月30日收治的215例老年性白内障手术患者的病案资料及单病种结算费用信息,采用描述性分析、新灰色关联分析和建立多因素线性回归模型分析单病种结算费用的构成、影响因素以及人工晶体材料费负担情况。结果 治疗费、人工晶体费和诊断费是构成老年性白内障手术患者住院费用的主要费用类型(占比分别为52.12%、19.79%、13.56%,合计占85.47%),同时也是影响次均住院费用的主要费用类型(关联度分别为1.000、0.751、0.717);多因素线性回归分析显示,住院天数、麻醉方式(以局部麻醉为参照,全身麻醉β=3 513.340)和人工晶体类型(以软性球面三片式单焦点非散光型为参照,软性非球面一片式单焦点散光型β=2 590.090,软性非球面一片式连续视程非散光型β=10 496.020,软性非球面一片式三焦点非散光型β=21 889.810)是住院费用的影响因素(P<0.001);人工晶体材料费医保限额支付下,所选人工晶体单价≤最高限额标准(1 800元)时患者最高负担比例较低,所选人工晶体单价>最高限额标准(1 800元)时患者最高负担比例随着人工晶体价格的增加而增加。结论 人工晶体集中带量采购政策下老年性白内障手术患者住院费用结构趋于合理,医务人员劳务价值得以体现,但后续应重点关注人工晶体费和诊断费的变化。缩短住院天数、合理选择麻醉方式、合理选择不同类型的人工晶体以及降低人工晶体价格可有效降低老年性白内障手术患者住院费用。根据属地医保基金承受能力适当上调人工晶体材料费限额标准有助于�Objective To study the single-disease settlement cost and its influencing factors for age-related cataract surgery patients under the centralized volume-based procurement policy of intraocular lens,and to provide theoretical suggestions and data support for optimizing the cost structure,controlling the growth of medical costs,and improving the quota payment policy of intraocular lens materials.Methods The medical records and single-disease payment information of 215 age-related cataract patients admitted to the Department of Ophthalmology of a provincial tertiary public general hospital in Guangzhou from June 1,2021 to April 30,2022 were collected.Descriptive analysis,new grey correlation analysis and multiple linear regression model were used to analyze the composition and influencing factors of single-disease settlement expenses and the burden of intraocular lens materials.Results The treatment cost,intraocular lens cost and diagnosis cost were the main types of hospitalization expenses for age-related cataract surgery patients(accounting for 52.12%,19.79%and 13.56%respectively,accounting for 85.47%in total).At the same time,it was also the main type of expense affecting the average hospitalization expense per time(the correlation coefficients were 1.000,0.751,0.717).Multiple linear regression analysis showed that the length of hospital stay,anesthesia type(local anesthesia as the reference,general anesthesiaβ=3513.340)and intraocular lens type(soft spherical three-piece monofocal non-astigmatism type as the reference,soft aspheric one-piece monofocal astigmatism typeβ=2590.090;soft aspheric one-piece continuous visual field non-astigmatism typeβ=10496.020,soft aspheric one-piece trifocal non-astigmatism typeβ=21889.810)were the influencing factors of hospitalization expenses(P<0.001).Under the medical insurance limit payment of intraocular lens material fee,the proportion of the highest burden of patients is low when the selected intraocular lens unit price is less than the maximum limit standard(1800 yuan

关 键 词：老年性白内障 住院费用 影响因素 人工晶体 单病种 

分 类 号：R197.1[医药卫生—卫生事业管理]