| 武汉市肺结核患者直接医疗费用及其影响因素 |
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| 引用本文： | 张帆,申丽君,刘昭,刘跃华.武汉市肺结核患者直接医疗费用及其影响因素[J].中华疾病控制杂志,2019,23(10):1279-1283,1292. |
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| 作者姓名： | 张帆 申丽君 刘昭 刘跃华 |
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| 作者单位： | 100191 北京,国家卫生健康委卫生发展研究中心,卫生技术评估科室;518055 深圳,清华大学医院管理研究院 |
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| 基金项目： | 国家自然科学基金71804032教育部人文社会科学研究规划基金/青年基金/自筹经费项目16YJCZH064中国疾病预防控制中心结核病防治合作项目（三期）2019-102 |
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| 摘 要： | 目的 通过对2011-2018年武汉市1.7万例肺结核患者直接医疗费用及其影响因素分析，研究肺结核患者疾病医疗负担，为结核病患者相关保障政策优化提供依据。 方法 对125万条医保结算信息使用秩和检验，对住院、门诊直接医疗费用分组分析；使用多元线性回归和广义线性估计模型，对患者单次住院及年费用进行多因素分析。 结果 次均门诊、次均住院、年人均直接医疗费用依次为147.51元、8 849.57元、9 607.01元，次均门诊报销比6.36%，住院报销比为67.56%。患者性别、年龄、医保类型、医院级别、是否进行手术、是否使用中药及就医发生年份为直接医疗费用的主要影响因素（均有P < 0.01）。 结论 现有肺结核患者住院医疗费用在可负担范围内，贫困结核患者疾病负担较重，结核治疗周期长，门诊保障不足，亟待出台有针对性的门诊报销统筹政策。
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| 关 键 词： | 肺结核 直接医疗费用 影响因素 |
| 收稿时间： | 2019-05-06 |
Direct medical expenses and its influencing factors of patients with pulmonary tuberculosis in Wuhan |
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| Affiliation: | 1.Health Technology Assessment Section, China National Health Development Research Center, Beijing 100191, China2.Institution for Hospital Management of Tsinghua University, Shenzhen 518055, China |
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| Abstract: | Objective To analyze the direct medical expenses and its influencing factors of patients with pulmonary tuberculosis (TB) from 2011 to 2018 in Wuhan, so as to provide references for improving the TB derating policy. Methods A total of 1 258 953 medical records were studied, the direct medical expenses and its influencing factors were analyzed by rank sum test, multivariable linear regression and generalized estimated equation. Results The average direct medical expense of TB outpatients was 147.51 yuan each time, while that of TB inpatients was 8 849.57 yuan; and the average direct medical expenses of each year was 9 607.01 yuan per person. The average reimbursement ratio for TB outpatients was 6.36%, and 67.56% for inpatients. Analysis on the influencing factors showed that the direct medical expenses were related with patients' age, sex, year, health care insurance, medical institution and whether they had surgery and Chinese traditional medicine or not (all P < 0.01). Conclusions The current direct medical expenses of TB inpatients are relatively affordable, but low-income patients and patients still have heavy financial burden. TB treatment cycle is long and the outpatient medical service B also safficient. Improved derating policy is in need. |
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