【作者】 刘兴和；

【导师】 徐凌中；

【作者基本信息】 山东大学 ， 社会医学与卫生事业管理， 2008， 硕士

【摘要】 研究背景目前我国的医疗保障制度改革正处于关键时期,其有效运作的关键是控制医疗费用上涨。而近年来,我国的医疗费用每年以30%的速度增长,远远地超出了国内生产总值的增长速度,势必影响我国经济的发展和人民生活水平的提高。因此如何控制医疗费用迅速上涨已成为人们所关注和亟待解决的问题。在医疗费用构成中,住院费用所占比例较大,同时也是研究者最关注的问题。要有效地控制医疗费用上涨,尤其是住院费用的上涨,首先需要明确住院费用的影响因素。当前,各地医疗费用管理体制改革不断深入,有关疾病医疗费用的统计分析可以为进一步深化医疗费用体制的改革提供有价值的参考数据。运用科学的方法进行单病种住院医疗费用的研究,对有效的利用卫生资源,发挥其最大的医疗效益和保证医疗质量、控制医疗费用的失度增长具有重要的实用价值。研究目的本研究对内蒙古民族大学附属医院2001-2006年的肺癌住院病人住院费用进行了系统分析,通过对肺癌这一常见病6年来住院医疗费用在时间序列上的对比分析,以及影响住院费用的诸多因素进行回归分析,并对影响因素的相关性大小进行排序,以掌握病人住院费用的分布构成情况及其影响因素,为医院决策者制定费用控制措施,更好的控制住院费用,提供积极的参考依据。研究方法本调查选择内蒙古民族大学附属医院(三级甲等医院),整理2001-2006年每年出院诊断为肺癌的住院病历和住院费用为结算资料。首先按照人民卫生出版社出版的全国高等医药院校教材第六版《外科学》,关于肺癌的诊断依据和标准确定纳入病例,剔除不符合研究条件的住院病例,6年内共得到患有肺癌的有效病历资料共534份,纳入本研究,对其住院费用的构成、随着时间的变化趋势以及影响住院费用的因素进行分析。本次调查所采用的统计方法为描述性分析、多因素回归分析以及时间序列的对比分析,采用的统计软件包是SPSS13.0统计分析软件,进行统计分析。主要研究结果主要研究结果包括:(1)总的来看,病人住院费用构成以药费所占比重最大,为34.3%～49.5%。(2)公费医疗和参加医疗保险的病人住院费用较高。(3)住院费用与住院天数的相关性检验结果显示,住院费用与住院天数的Pearson相关系数为0.782,p＜0.001,认为住院费用与住院天数之间呈正的直线相关关系。(4)多因素回归分析结果显示,影响住院费用的因素是多方面的,包括住院时间、负担形式、住院天数、伴随疾病和麻醉方式等。其中住院天数是影响住院费用的一个非常重要的因素。结论与建议(1)合理收费,降低药品费用和避免药物滥用,杜绝不良现象;(2)合理检查,避免滥检查、滥化验,减轻病人负担;(3)改变技术服务收费与药品收费价格倒置的现状;(4)严格抑制一次性物品的使用,降低医疗器材和一次性医用耗材的价格;(5)提高医护人员的业务能力,加强医德医风教育;(6)建立社区卫生服务体系,满足居民卫生服务需求,降低住院医疗费用;(7)加强病种质量管理,控制单病种费用;(8)完善医疗服务补偿机制,调整医疗服务价格,对医疗费用进行宏观调控。更多还原

【Abstract】 BackgroundAt present, China’s health care reform is at a critical period, the key of whose effective operation is to control the rising medical costs. In recent years, medical expenses of our country has increased at a rate of 30% yearly, far exceeding the GDP growth rate, which is bound to affect China’s economic development and people’s living standards. Therefore, how to control the rapidly rising medical costs has become a serious problem. In the constitution of medical expenses, hospital fees account for a larger proportion and so cause a most concern. To effectively control the rising cost of health care, particularly of the hospital costs, it need to find out the affecting factors of hospital fees. At present, the cost of health care around the deepening of reform of the management system, the diseases of the statistical analysis of medical expenses for medical expenses to further deepen the reform of the system to provide valuable reference. The use of scientific methods of single disease hospital for medical expenses, on the effective use of health resources, and make the best health care benefits and guarantee the quality of health care, control health care costs increase with the degree of loss of important practical value.ObjectiveThis study is to systematically analyze in-patients fees of lung cancer had by utilizing the common 6-year-patient medical expenses in Inner Mongolia National University Hospital. The analysis methods include comparative analysis of time series and affecting factors regression analysis. Through analyzing the distribution and its impact factors of in-patient fees, provide a reference for hospital managers to effectively control the cost of hospital fees, improving the hospital’s development.MethodsInvestigation of the choice of Inner Mongolia National University Hospital (tertiary-level hospital), finishing the year 2001-2006 for each of the discharge diagnosis of lung cancer in-patient medical records and billing information for the hospital fees. First of all, according to the People’s Health Publishing House national institutions of higher medical teaching sixth edition of "Science", on the basis of lung cancer diagnosis and determine the criteria included in the case, not out of line with the conditions of in-patient case studies, a total of 6 years has been suffering from lung cancer A total of 534 valid copies of medical records, Included in this study, the composition of their hospital fees, as time changes, as well as the factors that affect the cost of hospitalization for analysis. The survey of the statistical methods used for descriptive analysis, regression analysis and time series analysis comparing the use of statistical software package is SPSS13.0 statistical analysis software for statistical analysis.ResultsThe results of this study is more abundant, including: (1) Overall, the cost of patient medication in order to constitute the largest share, 34.3 percent to 49.5 percent. (2) public health and medical insurance to participate in the high cost of hospitalization. (3) the cost of hospitalization and length of hospital stay of the relevance of the findings revealed that the cost of hospitalization and length of hospital stay of the Pearson correlation coefficient 0.782, p<0.001, That the cost of hospitalization and length of hospital stay in a straight line between the positive correlation. (4) multi-factor regression analysis showed that affect the cost of hospitalization a wide range of factors, including the length of stay, in the form of burden, the number of days of hospitalization, anesthesia and associated diseases, and so on the way. One length of hospital stay influencing the cost of hospitalization of a very important factor.Conclusions and recommendations(1) reasonable charges, a reduction in the cost of drugs and avoid drug abuse, put an end to an undesirable situation; (2) reasonable inspection, to avoid over-inspection, over-testing to reduce the burden on patients; (3) changed technologies and drugs charges the price inversion The status quo; (4) to strictly curb the use of one-time items, medical equipment and the lower one-time price of medical supplies; (5) to enhance the operational capacity of health care, strengthen the medical ethics education; (6) the establishment of community health service system to meet the needs of residents and health services, reduce in-patient medical expenses; (7) to strengthen quality control of diseases, control the cost of single disease ; (8) to improve medical services compensation mechanism to adjust the price of medical services, medical expenses to carry out macro-control.更多还原