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目的分析脑卒中患者住院费用构成及影响因素,为合理控制脑卒中医疗费用,减轻个人和社会的经济负担提供参考依据。方法收集广西2所三级医疗机构2003年、2008年和2013年脑卒中住院患者的6 080例完整病历资料进行回顾性分析。采用非参数检验对脑卒中患者住院费用的影响因素进行单因素分析,用多元线性逐步回归分析进行多因素分析。结果 6 080例脑卒中住院患者男性(67.22%)多于女性(32.78%),脑梗死(80.82%)多于脑出血(18.03%)。患者实际住院天数中位数为12 d,次均住院费用中位数为12 543.80元,脑卒中患者住院次均费用是总住院患者次均费用的1.40倍,其中2003年、2008年、2013年脑卒中患者次均住院费用分别为7 639.41、8 685.97和15 589.24元,3个年度的费用呈逐渐增加的趋势,差异均有统计学意义(χ2=2 780.976,P<0.01)。扣除物价影响因素后,自2004年以来,10年间广西脑卒中患者次均住院费用年增长速度为4.59%。各类费用构成中以药品类所占比例最高(46.97%),单项费用中以西药费、检查诊断费较高,分别为46.17%、23.99%。影响住院费用的主要因素依次为实际住院天数、手术治疗、脑卒中亚型、合并2型糖尿病(T2DM)。结论广西三甲医院脑卒中患者住院费用明显高于全国的平均水平,且费用构成不合理。规范医院管理,缩短无效住院日,严格控制病情,可有效减少患者的住院费用,减轻脑卒中直接经济负担。
Objective To analyze the composition and influencing factors of hospitalization expenses in stroke patients and provide reference for rationally controlling the medical expenses of stroke and alleviating the financial burden on individuals and society. Methods The data of 6080 cases of hospitalized patients with stroke in 2003, 2008 and 2013 from two tertiary medical institutions in Guangxi were retrospectively analyzed. Univariate analysis was used to analyze the influencing factors of hospitalization expenses in stroke patients by multivariate analysis using multivariate linear stepwise regression analysis. Results 6 080 hospitalized stroke patients were more likely to be hospitalized (67.22%) than women (32.78%), with cerebral infarction (80.82%) more than those with cerebral hemorrhage (18.03%). The median length of hospitalization was 12 days, and the median cost of hospitalization was 12 543.80. The average cost of hospitalization for stroke patients was 1.40 times of the average cost of inpatients, including 2003, 2008 and 2013 The average hospitalization expenses for stroke patients were 7639.41, 8685.97 and 15589.24 yuan, respectively. The cost of three years showed a trend of gradually increasing, the differences were statistically significant (χ2 = 2 780.976, P <0.01). After deducting the influencing factors of price, since 2004, the annual growth rate of per capita hospitalization expenses of stroke patients in Guangxi in 10 years is 4.59%. The composition of various types of medicines accounted for the highest proportion of drugs (46.97%), and the individual charges were mainly for western medicines and diagnostic and diagnostic fees, accounting for 46.17% and 23.99% respectively. The main factors influencing the hospitalization costs were the actual days of hospitalization, surgical treatment, stroke subtype and type 2 diabetes mellitus (T2DM). Conclusion The hospitalization expenses of stroke patients in Guangxi No.3 A hospital were significantly higher than the national average, and the costs were not reasonable. Standardize hospital management, shorten the invalid hospital stay, strict control of the disease, can effectively reduce the patient’s hospitalization costs and reduce the direct economic burden of stroke.