上海交通大学学报(医学版) ›› 2013, Vol. 33 ›› Issue (6): 746-.doi: 10.3969/j.issn.1674-8115.2013.06.009

• 专题报道(卫生系统研究) • 上一篇    下一篇

急性心肌梗死患者住院费用分析和影响因素研究

顾 倩1, 马 进2, 李 娜2, 袁素维2   

  1. 上海交通大学 1.瑞金临床医学院, 上海 200025; 2.公共卫生学院, 上海 200025
  • 出版日期:2013-06-28 发布日期:2013-06-28
  • 通讯作者: 马进, 电子信箱: majin_sph@sjtu.edu.cn。
  • 作者简介:顾倩(1982—), 女, 硕士生; 电子信箱: gq30423@rjh.com.cn。
  • 基金资助:

    国家自然科学基金(71203141);上海市卫生局基金(2010Y100)

Analysis of hospital expenditure and influencing factors of patients with acute myocardial infarction

GU Qian1, MA Jin2, LI Na2, YUAN Su-wei2   

  1. 1.Ruijin School of Clinical Medicine, 2.School of Public Health, Shanghai Jiaotong University, Shanghai 200025, China
  • Online:2013-06-28 Published:2013-06-28
  • Supported by:

    National Natural Science Foundation of China, 71203141; Shanghai Municipal Health Bureau Foundation, 2010Y100

摘要:

目的 分析急性心肌梗死(AMI)患者住院费用及其构成的变化趋势,阐明主要影响因素。方法 对上海交通大学医学院附属瑞金医院2007年1月—2012年8月住院的1 880例AMI患者的病案首页信息进行回顾,历年住院费用以2012年为基准,利用居民消费指数进行校正,并对可能影响该疾病住院费用的因素进行单因素分析和多因素回归,明确影响AMI患者住院费用的主要因素。结果 历年住院费用总体呈现上升态势,其中手术费占比最高(63.52%),其次为药费(17.57%)和检查费(13.16%)。诊疗费和护理费占比最低,分别为0.34%和0.38%。多元线性回归结果显示:患者的入院次数、住院天数、住院期间进行重症监护、手术方式以及出院疾病转归对AMI患者的住院费用影响显著(P<0.05)。偏回归系数分析结果表明:患者的住院天数对AMI患者的住院费用影响最大(b6=0.41),其次为手术方式(b8=0.35)。入院次数越多,费用越低(b4=-0.09);死亡病人的住院费用明显高于存活病人(b13=-0.08)。结论 医疗费用控制总体效果不明显,同时住院费用构成不合理,医务人员劳动价值仍未得到体现;住院天数和手术方式是影响AMI患者住院费用的主要因素。我国卫生事业改革必须注重规范医生的诊疗行为,缩短平均住院日,提高资源利用效率。

关键词: 急性心肌梗死, 住院费用, 影响因素

Abstract:

Objective To investigate the variation trend of hospital expenditure and its constitution in patients with acute myocardial infarction (AMI), and explore the influencing factors. Methods The information of home page of medical records of 1 880 patients with AMI hospitalized in Ruijin Hospital affiliated to Shanghai Jiaotong University School of Medicine between January 2007 and August 2012 was retrospectively analysed. The data of hospital expenditure were discounted by the consumer price indices based on 2012. Univariate analysis and multiple regression analysis were conducted to identify the main influencing factors of hospital expenditure. Results The hospital expenditure of patients with AMI exhibited a rising trend in general, and was mainly constituted by surgery fee (63.52%), medicine fee (17.57%) and examination fee (13.16%). The treatment charge and nursing charge ranked the lowest, which accounted for 0.34% and 0.38% respectively. The multiple regression analysis revealed that the times of admission, length of stay, ICU stay during hospitalization, surgery procedure and prognosis significantly affected the hospital expenditure (P<0.05). The partial regression coefficients indicated that length of stay had the greatest influence on hospital expenditure (b6=0.41), followed by surgery procedure (b8=0.35). The more times patients got into hospital, the less was the hospital expenditure (b4=-0.09). Patients who died in hospital cost more than the survival ones (b13=-0.08). Conclusion The control of hospital expenditure in patients with AMI is not favorable as a whole, which is embodied by the irrational constitution of hospital expenditure and underestimation of labor value of medical staff. The length of stay and surgery procedure were the main influencing factors of hospital expenditure. In the health care reform, more efforts should be made to regulate the behavior of doctors, shorten the average length of stay, so as to improve the efficiency of health resource utilization.

Key words: acute myocardial infarction, hospital expenditure, influencing factors