成都市第三人民医院骨科2008～2010年住院患者疾病及费用构成调查

目的调查成都市第三人民医院骨科2008～2010年度住院患者疾病及费用构成情况,为后续析因分析主要住院疾病负担和有效干预提供更加详尽的基线数据。方法收集该院骨科2008—2010年住院患者病历,按国际疾病分类（ICD-10）标准对出院记录的第一诊断进行分类整理。结果2008—2010年该院骨科住院患者逐年增加,男性以中青年为主,女性以老年为主;3年内前5位系统疾病顺位未变,有6个单病种均保持位于前10位。患者人均费用平均增长8．97％;住院费用构成前三位保持不变,依次为材料费、药品费和治疗费;住院费用支付方式构成前三位依次为自费、社保和公费;支付方式构成中,社保支付呈明显上升趋势,自费支付总体以下降为主。结论①该院2008～2010年骨科住院患者人数呈逐年增高趋势,患者性别与年龄分布趋于稳定。②按ICD-10一级代码分类的疾病谱和单病种较稳定,首位疾病3年来均为腰椎间盘突出症,而股骨转子间骨折上升趋势最明显。③人均住院费用呈逐年上涨趋势,材料费和检查费构成比增长明显,手术费、治疗费和床位费较低,未来应研究如何“多管齐下”控制医疗费用增长和使费用构成合理化。④住院费用支付方式构成中,自费构成逐渐下降,社保构成逐渐上升,说明国家社保医疗保障范围得到进一步扩大。

Status Survey on Orthopaedic Inpatient's Disease and Cost Constitution of the Third People's Hospital of Chengdu during 2008-2010

Objective To investigate the orthopaedic inpatients＇ disease and cost constitution of the Third Peo- ple＇s Hospital of Chengdu during 2008-2010, so as to provide detailed baseline data for further research on the factorial analysis of disease burden and effective intervention. Methods The medical records of inpatients in orthopaedic depart- ment of the hospital during 2008-2010 were collected, and the diseases based on the first diagnosis on discharge records were classified according to the International Classification of Diseases （ICD-10）. Results During 2008 to 2010, the total number of inpatients increased year by year. Most of the male inpatients were the young and middle-aged, while the female were the old. The rank order of top 5 systematic diseases didn＇t change, while there were 6 single diseases kept ranking as top 10 in those 3 years. The average cost per capita averagely grew by 8.97%. The top 3 constitution of hospitali- zation cost remained the same, which were material cost, drug cost, and treatment cost; while the top 3 payment modes of hospitalization cost were patient＇s own expense, social security, and public expense. Among those payment modes, social security rose obviously, and patient＇s own expense reduced generally. Conclusion a） The total number of inpa- tients increases yearly during 2008-2010, and the gender and age distribution of inpatients are tending towards stability. b） The spectrum of disease and single diseases classified according to the one-level code of ICD-10 are relatively stable in those 3 years; of which the top ranked disease is lumbar disc herniation, and the disease with most obviously rising trend is intertrochanteric fracturethe, c） The hospitalization cost per capita rises year by year, of which the constituent ratio of both material and examination costs grow obviously, but the operation, treatment and bed costs are still lower. It requires a multi-pronged approach to control the increase of hospitalization cost as well as the rationalization of cost constitution. d） Among all payment modes of hospitalization cost, the constituent ratio of patient＇s own expense reduces year by year, while social security rises, indicating the medical security in national social security has been further expanded.