康复病种住院费用医保结算影响因素分析  

Analysis of influencing factors on insurance settlement of inpatient expenses for four rehabilitation disease types

作　　者：周亚斌 张祁 尹萌 池硕 桂子麟 郭元吉[1] 密忠祥[1,2] ZHOU Yabin;ZHANG Qi;YIN Meng;CHI Shuo;GUI Zilin;GUO Yuanji;MI Zhongxiang(Beijing Bo'ai Hospital,China Rehabilitation Research Center,Beijing,100068,PRC)

机构地区：[1]中国康复研究中心北京博爱医院,北京市100068 [2]首都医科大学康复医学院,北京市100068

出　　处：《中国医院》2024年第11期56-58,共3页Chinese Hospitals

基　　金：中国康复研究中心科研课题(2023ZX-23)。

摘　　要：目的:以脑梗塞患者为例,分析某三级甲等康复医院住院患者的费用构成以及相关影响因素,为完善医保支付政策提供参考建议。方法:筛选2019-2023年脑梗塞患者的病案首页及费用明细结算数据,利用统计学方法对数据统计结果、重点病例进行分析。结果:纳入研究的2572例病例,平均年龄在60岁,平均住院天数为45天,平均住院费用为70133.50元;住院总费用以治疗费、药费、固定费用为主,累计占比为81.55%,其中治疗费以康复治疗费为主,占比75.43%;患者的住院天数、入院ADL等级、有无认知障碍、发病时间距离入院时间、并发症与合并症情况、有无吞咽障碍、有无抑郁状态和年龄是影响住院费用的主要因素。结论:在不同医保支付政策下,进行康复病种费用支付时需关注相关因素的影响,建议推行以患者为中心,以功能相关分类为依据,关注康复效果,同时考虑影响康复患者住院费用的主要因素为原则的医保支付政策。Objective:Using cerebral infarction patients as an example,this study analyzes the composition of inpatient expenses and related influencing factors at a Grade III Level A rehabilitation hospital,providing reference suggestions for improving medical insurance payment policies.Methods:The study selected medical records and expense settlement data of cerebral infarction patients from 2019 to 2023.Statistical methods were used to analyze the statistical results and key cases.Results:A total of 2,572 cases were included in the study,with an average age of 60 years,an average hospital stay of 45 days,and an average inpatient cost of 70,133.50 yuan.The total inpatient expenses were primarily composed of treatment fees,drug fees,and fixed costs,cumulatively accounting for 81.55%,with treatment fees mainly comprising rehabilitation treatment fees,which accounted for 75.43%.The main factors influencing inpatient expenses were the length of hospital stay,admission ADL level,presence of cognitive impairment,time from onset to admission,complications and comorbidities,presence of swallowing disorders,presence of depression,and age.Conclusion:Under different medical insurance payment policies,it is necessary to consider the impact of relevant factors when determining payment for rehabilitation-related diseases.It is recommended to implement a patient-centered approach,based on function-related classifications,focusing on rehabilitation outcomes,and simultaneously taking into account the main factors that affect inpatient expenses for rehabilitation patients as the guiding principles for medical insurance payment policies.

关 键 词：康复病种 住院费用 因素分析 医保支付 

分 类 号：R197.3[医药卫生—卫生事业管理]