结直肠恶性肿瘤手术住院医疗费用结构变动与影响因素研究  

Analysis on the Structural Variation and Influencing Factors of Hospitalization Expenses of Patients with Colorectal Cancer Surgery

作　　者：林苡竹 吕婕[1] 周亚旭 刘雅娟 Lin Yizhu;Lv Jie;Zhou Yaxu;Liu Yajuan(Xinhua Hospital Affiliated to Shanghai JiaoTong University School of Medicine,Shanghai 200092,China;不详)

机构地区：[1]上海交通大学医学院附属新华医院,上海市200092 [2]上海交通大学医学院附属仁济医院,上海市200127 [3]上海申康医院发展中心,上海市200041

出　　处：《中国病案》2024年第6期72-76,共5页Chinese Medical Record

基　　金：上海市医院协会医院管理研究基金2022年立项青年课题(Q2022062);上海市医院协会医院医疗保险管理专委会2022年医保管理重点立项课题(E2022012)。

摘　　要：目的 对上海市某三甲综合医院结直肠恶性肿瘤手术患者住院费用结构变化和影响因素分析,为控制医疗费用增长、调整病种费用结构、提升肿瘤患者诊疗质量提供参考。方法 回顾性分析2019年1月1日-2021年12月31日某院3047例结直肠恶性肿瘤手术患者住院数据,包括患者基本信息、医保类型及医疗费用。运用统计描述、结构变动度法、多元线性回归法分析结直肠癌手术患者的住院费用结构变动情况及其影响因素。结果引起结直肠癌手术患者住院医疗费用结构变动的主要项目是检查费(CSV=36.03%)、药品费(CSV=31.01%)及手术费(CSV=13.97%),三者累计贡献率达81.01%。其中检查费拉力值最高(5.30),手术费其次(0.59),药品费拉力值呈负值(-2.65);单因素分析结果中性别、医保类型、年龄、住院天数均为影响因素,具有统计学意义,P<0.1,多元线性回归分析结果显示医保类型、年龄、住院天数是医疗总费用主要影响因素,差异具有统计学意义,P<0.05。结论 关注药品、耗材等医疗成本管控,关注肿瘤患者健康管理,强化规范临床诊疗行为,从而使医疗费用结构趋于合理化,减轻患者医疗费用负担。Objectives By analyzing the structural variation and influencing factors of hospitalization cost of patients with colorectal cancer surgery in a grade-three general hospital in Shanghai,so as to provide references for controlling the increase of medical cost for colorectal cancer,adjusting the cost structure of specialized diseases and improving the level of medical management.Methods The inpatient data of 3047 patients undergoing colorectal cancer surgery in a hospital from January 1st,2019 to December 31st,2021 were retrospectively analyzed,including the basic information of patients,types of medical insurance and medical expenses.Statistical description,structural variation and multiple linear regression were used to analyze the structural changes of hospital expenses in patients with colorectal cancer surgery and its influencing factors.Results The main items that caused the change of inpatient medical cost structure of patients undergoing colorectal cancer surgery were examination cost(CSV=36.03%),drug cost(CSV=31.01%)and operation cost(CSV=13.97%),and the cumulative contribution rate of the three was 81.01%.The tensile value of examination fee was the highest(5.30),followed by surgery fee(0.59),and the tensile value of pharmaceutical products was negative(-2.65).In the results of univariate analysis,gender,type of medical insurance,age and length of stay were all influencing factors,with statistical significance(P<0.1);the results of multiple linear regression analysis showed that type of medical insurance,age and length of stay were the main influencing factors of total medical expenses,with statistical significance(P<0.05)Conclusions We should strengthen the standardization of clinical diagnosis and treatment behavior,pay attention to the control of medical costs such as drugs and consumables,and pay attention to the health management of tumors,so as to rationalize the structure of medical expenses and reduce the burden of medical expenses on patients.

关 键 词：结直肠恶性肿瘤 住院医疗费用 结构变动度 影响因素1 

分 类 号：R197.323[医药卫生—卫生事业管理]