山东省某三甲医院基本医疗保险患者膝关节置换术住院费用及影响因素  

Hospitalization expenses and influencing factors for medical insurance patients undergoing knee replacement in a grade-A tertiary hospital in Shandong Province

作　　者：岳毅[1] 张清 YUE Yi;ZHANG Qing(Medical Insurance Office,The First Affiliated Hospital of Shandong First Medical University&Shandong Provincial Qianfoshan Hospital,Jinan 250014,Shandong,China;Shandong Second Provincial General Hospital,Jinan 250022,Shandong,China)

机构地区：[1]山东第一医科大学第一附属医院(山东省千佛山医院)医疗保险管理办公室,山东济南250014 [2]山东省第二人民医院,山东济南250022

出　　处：《山东大学学报（医学版）》2024年第3期92-99,共8页Journal of Shandong University:Health Sciences

基　　金：国家社会科学基金(20BGL263)。

摘　　要：目的探讨医保患者行膝关节置换术住院费用的影响因素,分析人工关节集采前后住院费用的变化,为相关研究及卫生决策提供参考。方法构建广义线性模型,对山东第一医科大学第一附属医院2021年1月至2022年10月行膝关节置换术3631例患者的住院费用进行影响因素分析,采用倾向得分匹配得到的均衡数据集分析人工关节集采前后费用结构的变化。结果患者参保类型、手术部位、手术类型、疾病类型、集采、住院天数、年龄均为医保患者膝关节置换住院费用的影响因素;人工关节集采后,膝关节置换术患者的平均住院费用由48928.24元降为26365.42元,平均材料费由33762.06元降为10939.82元,材料费占比由69.00%降为41.49%。结论膝关节置换术住院费用中材料费占比最大,是否集采是对住院费用影响最大的因素,集采后材料费和住院费用显著降低,减轻了膝关节置换术患者的经济负担。Objective To explore factors influencing the hospitalization expenses of medical insurance patients undergoing knee replacement and to analyze the changes in hospitalization expenses before and after centralized volume-based procurement of artificial joints,so as to provide reference for relevant research and healthcare decision-making.Methods A generalized linear model was constructed to analyze the factors influencing hospitalization expenses of 3,631 patients undergoing knee replacement in the First Affiliated Hospital of Shandong First Medical University during Jan.2021 and Oct.2022.Balanced data set obtained by propensity score matching were used to analyze the changes in cost structure before and after centralized procurement.Results The types of medical insurances,surgical sites,surgical types,types of diseases,centralized procurement,length of hospitalization and patients'ages were factors influencing hospitalization expenses.After centralized procurement,the average hospitalization expenses decreased from 48,928.24 CNY to 26,365.42 CNY,the average material costs decreased from 33,762.06 CNY to 10,939.82 CNY,and the proportion of material costs decreased from 69.00%to 41.49%.Conclusion The material costs account for the largest proportion in the hospitalization expenses of knee replacement,and centralized procurement is the most influential factor affecting hospitalization expenses.The material costs and hospitalization expenses are significantly reduced by centralized volume-based procurement of artificial joints,which reduces the economic burden of patients.

关 键 词：住院费用 膝关节置换术 人工关节集采 医用高值耗材 费用分析 

分 类 号：R197[医药卫生—卫生事业管理]