2014 - 2016年广西三甲综合医院住院费用结构变动情况分析

目的 分析大型公立综合医院住院费用结构变动趋势及特征，为控制住院费用过快增长提供循证依据。方法 收集24所广西三甲综合医院2014 - 2016年的住院患者费用资料，采用结构变动度进行分析。结果 广西三甲综合医院住院人均费用逐年增长，2015年和2016年广西三甲等综合医院住院人均费用增长率分别为5.59%和3.23%。2014 - 2016年各项费用占比前5位均包括药品费、卫生材料费、化验费、治疗费和检查费，药品费和治疗费占比逐年下降。2014 - 2016年广西三甲等综合医院药品费、床位费和治疗费的结构变动值呈负向变动，检查费、化验费、卫生材料费、诊察费、手术费和护理费的结构变动值则均呈正向变动。2014 - 2016年对住院费用结构变动贡献前5位项目依次为药品费（31.60%）、卫生材料费（27.40%）、治疗费（12.52%）、化验费（7.43%）和检查费（7.36%），这5项累积贡献率达86.31%。结论 住院人均费用增速下降，药费控制政策初见成效。但药占比仍然较高，费用结构不合理，卫生材料费、化验费和检查费占比逐年上升，体现医护人员技术劳务价值的手术费、护理费等费用项目比重较低。

Analysis of the change of hospitalization expenses structure from 2014 to 2016 in one top tertiary hospital of Guangxi

Objective To explore the trend and characteristics of hospitalization expenses structure change in top tertiary hospitals, and to provide evidence for the irrational increase of hospitalization expenses. Methods Collecting the hospitalization expenses from 2014 to 2016 in 24 top tertiary hospitals in Guangxi of a medical university, and the indices of structural variation, degree of structural variation, and contribution rate of structural variation were used for statistical analysis. Results In 2015 and 2016, the growth rate of per capita hospitalization expenses in Guangxi tertiary general hospitals was 5.59% and 3.23% respectively. As the top 5 in proportion of all expenses, drug fees, medical materials fees, treatment fees, laboratory fees and inspection fees were the main items that caused the changes in income structure, and the proportion of drug fee and treatment fee decreased year by year. The inspection charges, laboratory charges, medical material charges and operation charges show positive changes in the structural variation but drug charges, examination charges, bed charges, treatment charges, and nursing charges show negative changes. The top five items which contribute most to structural variation were drug fees (31.60%), medical material fees (27.40%), the treatment fees (12.52%), examination fee and laboratory fees (7.43%) and inspection fees (7.36%), and the cumulative contribution rate of the five items was 82.96%. Conclusion The per capita hospitalization expenditure growth rate has declined, and the policy of drug fees control has achieved initial success. However, the proportion of drugs is still high, and the cost structure is unreasonable, and the cost structure needs to be adjusted and optimized.