脑梗死患者不同付费方式对住院费用影响

摘要：目的　比较不同付费方式下脑梗死患者住院费用的差别，并进行效率分析，找出差异的原因，提出
合理控制住院费用的思路。方法　采用回顾性调查法收集某三级甲等医院的出院病人首页中第一诊断为脑
梗死的住院病例，采用ＳＡＳ９．２和ＤＥＡＰ２．１软件进行单因素方差分析和χ
２ 检验对患者基本情况和费用进
行分析，并用数据包络分析评价住院费用效率，犘＜０．０５为差异有统计学意义。结果　除药费和检查化验
费外，不同付费方式下患者的一般医疗服务费（犉＝９．４６，犘＜０．０１）、护理费（犉＝５．７４，犘＝０．００３４）、
治疗费（犉＝４．０９，犘＝０．０１７３） 和总费用（犉＝４．２４，犘＝０．０１４８） 差异均有统计学意义，住院日（犉＝
１４．２０，犘＜０．０００１）和治疗结果（χ
２＝１４．８０４，犘＝０．０２２）之间差异均有统计学意义，医疗保险和自费的
相对效率优于公费医疗。结论　医疗卫生管理部门应从药费、检查化验费、住院天数等方面重点监控住院
费用，进一步推广新型农村合作医疗保险，加大对公费医疗的改革制度，减轻脑梗死患者的经济负担。
关键词：脑梗死；住院费用；付费方式；效率分析；医疗服务费
中图分类号：Ｒ１９７　　文献标识码：Ａ　　文章编号：１００９ ６６３９ （２０１４）０１ ００１３ ０４

Effect of payment plans on the cost of hospitalization for patients with cerebral infarction

Objective To compare the cost of hospital stay under different payment plans among patients with cerebral infarction, and to provide evidence for hospital cost control. Methods A retrospective survey was conducted to collect the information about hospitalization cost of patients with cerebral infarction and payment plans in a local hospital. One-way ANOVA, Chi square test and data envelopment analysis （DEA） were ap plied for data statistical analysis. Results Except for drug and test costs, the differences of costs under three payment plans were significant in general medical service （F=9.46, P〈0. 0001）, nursing care （F= 5.74, P 5.74）, treatment （F 4.09, P 0.0173） and total cost （F 4.24, P 4.24） .Also, there were statistical differences in days of hospital stay （F= 14.20, P〈0. 0001） and hospitalization outcomes （= 14. 804, P=14. 804） . Patients with health insurance and those who stayed in hospital at their own expenses usually pay less compared to patients with public health services. Conclusion The medical and health management should monitor the cost of drugs, tests and hospital stay days, popularize the NRCMS and reform public medical service in order to reduce the financial burden among patients with cerebral infarction.