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目的分析常见疾病医保和自费患者的住院费用现状及影响因素,为社保机构和医疗机构制定合理有效的费用监管措施提供参考依据。方法资料来自新疆某三甲综合性医院住院2014全年HIS系统中的2型糖尿病、脑梗死、冠状动脉粥样硬化性心脏病、急性化脓性阑尾炎等4种常见疾病,共计2564例。采用非参数检验对医保与自费患者的费用构成对比分析,利用多元线性逐步回归对住院费用影响因素进行分析。结果 2型糖尿病的住院费用、住院天数在医保和自费患者间有显著性差异,医保患者的住院费用10 975元、住院天数11.2天均高于自费患者7862元、7.5天。急性化脓性阑尾炎的住院费用在医保和自费间经检验有统计学差异,医保患者的住院费用15 041元高于自费患者的9108元。脑梗死医保患者的住院天数16.3天,高于自费患者的11.8天(P<0.05)。4种疾病的费用构成中,药品费所占比重较高,占到了住院费用的30%以上;影响医保和自费患者的住院费用的因素从大到小依次是住院天数、住院次数和年龄。结论医保与自费患者的住院费用存在差异,医保患者比自费患者消耗了更多的医疗资源。通过医疗机构内部费用监控、加强合理用药监管、优化薪酬分配体系,提升医护人员技术价值的方式均可控制住院费用的增长。
Objective To analyze the current status and influencing factors of hospitalization expenses of common medical insurance and self-pay patients, and provide reference for social insurance agencies and medical institutions to formulate reasonable and effective cost control measures. Methods The data were from 4 types of common diseases such as type 2 diabetes mellitus, cerebral infarction, coronary heart disease and acute suppurative appendicitis, which were hospitalized in a general hospital in Xinjiang in 2014 and totaled 2564 cases. Using nonparametric test to compare the cost of medical insurance and self-pay patients, the influencing factors of hospitalization expenses were analyzed by multivariate linear stepwise regression. Results The hospitalization cost and hospitalization days of type 2 diabetes patients were significantly different between Medicare and self-pay patients. The hospitalization expense of Medicare patients was 10 975 yuan, and the average days of hospitalization 11.2 days were higher than that of self-paid patients 7862 yuan and 7.5 days. Hospitalization costs of acute suppurative appendicitis in the health insurance and self-payment between the test was statistically significant, hospitalization costs 15 041 yuan higher than the expense of patients 9108 yuan. The days of hospitalization for Medicare patients with cerebral infarction were 16.3 days, which was 11.8 days higher than the patients who voluntarily paid their own expenses (P <0.05). Of the four diseases, the proportion of the cost of medicines is higher, accounting for more than 30% of the cost of hospitalization. The factors affecting the hospitalization expenses of medical insurance and self-pay patients are the length of hospitalization, the number of hospitalizations and the age in descending order. Conclusion There are differences in hospitalization costs between Medicare and self-pay patients, and Medicare patients consume more medical resources than patients who pay for Medicare. The cost of hospitalization can be controlled by monitoring the cost of medical institutions, strengthening the supervision of rational drug use, optimizing the remuneration distribution system and enhancing the technical value of medical staff.