新疆心脑血管疾病治疗费用核算与住院费用影响因素分析

目的 综合分析新疆心脑血管疾病总治疗费用现状，为医疗资源的合理配置提供理论依据。方法 通过多阶段分层随机抽样，收集2017年新疆心脑血管疾病患者样本信息。在SHA 2011框架下，采用自上而下的分摊方法，核算心脑血管疾病的治疗费用。建立线性回归模型，用以分析住院费用的影响因素。结果 心脑血管疾病总治疗费用达105.74亿元；占比67.22%的治疗费用发生在综合医院；排名前三位的疾病分别为冠心病、高血压和脑梗塞，占比达74.20%；65岁及以上老年人群花费占比为43.51%；县（区）级机构（t = - 218.362，P＜0.001）、市级机构（t = - 103.65，P＜0.001）、住院天数（t = 233.297,P＜0.001）、65岁以上人群（t = 58.422，P＜0.001）、手术情况（t = 101.514，P＜0.001）均是影响住院费用的主要因素。结论 新疆心脑血管疾病消耗大量医疗资源；防控工作重点关注老年人群；治疗费用机构流向有待优化，应强化基层医疗机构在防治慢病工作中的主导作用；缩短住院时间是有效控制治疗费用的直接途径。

Study on the influencing factors of treatment expenditure accounting and hospitalization cost of cardiovascular and cerebrovascular diseases in Xinjiang

Objective To comprehensively analyze the current status of total treatment expenditure of cardiovascular and cerebrovascular diseases (CVDs) in Xinjiang, and provide theoretical basis for the rational allocation of medical resources. Methods Multi-stage stratified cluster random sampling was used to collect the information of patients with CVDs in Xinjiang in 2017. Under the framework of System of Health Accounts (SHA) 2011, the top-down allocation method was adopted to calculate the treatment expenditure of CVDs. Multiple linear regression was used to analyze the influencing factors. Results The total treatment cost of cardiovascular and cerebrovascular diseases reached 10.574 billion yuan, and 67.22% of the treatment expenses occurred in general hospitals. The top three diseases were coronary heart disease, hypertension and cerebral infarction, accounting for 74.20%, and the elderly people aged 65 and over accounted for 43.51%. County (district) level institutions (t=-218.362, P<0.001), municipal institutions (t=-103.65, P<0.001), hospitalization days (t=233.297, P<0.001), people aged 65 and over (t=58.422, P＜0.001), and operation (t=101.514, P<0.001) were main factors affecting the hospitalization costs. Conclusion CVDs in Xinjiang consume a lot of medical resources, and prevention and control work focuses on the elderly. The flow of treatment expenditure needs to be optimized, and the leading role of primary medical institutions in the prevention and treatment of chronic diseases should be strengthened. Shortening the length of hospitalization is an effective way to control hospitalization costs.