【作者】 郝娟；

【导师】 刘越泽；

【作者基本信息】 山西医科大学 ， 社会医学与卫生事业管理， 2011， 硕士

【摘要】 目的本文围绕同一级别综合性医院病种住院费用影响因素展开研究,找出可能的影响因素及其对住院费用的作用强度,并结合当前费用控制方法提出合理的费用控制思路。通过对比分析同级别医院的住院费用及其影响因素,探讨住院费用在同一级别医院的异同,为病种合理定价提供参考。方法本文选择太原市两所二级甲等综合医院2009年全年出院的正常分娩和冠心病患者作为研究对象。数据资料来源于两院的病案室病历首页信息,剔除主要信息缺失的病例,符合标准的病例共589例,其中正常分娩201例(A院97例,B院104例),冠心病388例(A院176例,B院212例)。所有资料采用SPSS16.0进行统计分析。结果(1)A、B两院在病人来源、住院费用构成等多种住院费用影响因素上均有不同程度差异；(2)医疗保险在两院产妇中的覆盖率较低,分别为27.84%和5.77%；(3)相同病种平均住院费用不同,两院正常分娩平均住院费用分别为2195.16元和2719.91元,冠心病分别为5741.16元和9313.22元；(4)影响住院费用最主要的因素是住院天数和药品费用比例；(5)有效控制病种住院费用的主要方法有：结合临床路径缩短平均住院日,控制药品使用、降低药品费用比例,加强管理、引导合理医疗消费。结论育龄妇女参保情况值得关注；在衡量医院收费情况时,更应当关注收费结构的合理性而不仅仅是药品费用比例；同一病种即使在同等级医院,住院费用也不同,医保机构制定病种费率需考虑各种不可控因素；缩短住院天数和控制药费比例是控制费用的主要手段。更多还原

【Abstract】 Objective This paper focus on the factors of inpatient costs between the same class of general hospital, to identify possible influence factors and the intensity of the factors, and provide the reasonable cost control methods.Through the comparative analysis to analyze the hospitalization expense of the same class and its influence factor, to discuss the hospitalization expense at the same class for the same disease, to analyze the differences of hospital charges between the same class of general hospital, to provide reference for reasonable hospitalization expenses.Methods It chooses two upper second class general hospitals in Taiyuan,use single fetus natural delivery and coronary heart disease in 2009 as the sample.The data comes from the information of home page in the medical records, remove the single fetus natural delivery cases with secondary diagnosis and the cases of missing key information,standards-compliant patients were 589 cases, of which 201 patients with single fetus natural delivery (hospital A including 97 patients, hospital B 104 cases), coronary heart disease 388 (hospital A including 176 cases, hospital B including 212 cases). All data were analyzed by SPSS 16.0.Results(1) Both of the source of patient and inpatient cost structure have varying difference;(2) The coverage of health insurance in two hospital were 27.84% and 5.77%;(3) The same class hospital have different hospitalization costs, the average cost of single fetus natural delivery were 2,195.16 yuan and 2,719.91 yuan, coronary heart disease were 5,741.16 yuan and 9,313.22 yuan;(4)The most important influence factors of the hospitalization cost is the length of stay and the proportion of drug expenses;(5) The main effective methods of expenses control are:Combined with clinical trial to shorten the average length of stay, to control the drug use,to reduce the proportion of drug expenses, strengthen management, and to induce the rational health care consumption.Conclusion The insurance in women of childbearing age should be solved;When measuring hospital charges in the case, it should focus on the reasonableness of the charge structure rather than the proportion of drug costs; The same disease even in the same class hospital still have different costs, the uncontrollable factors should be considered when health care institutions formulate the cost standards; Shorten the length of stay and control the cost of medicine are the main methods to control the hospital expenses.更多还原