天津市城乡参保脑卒中住院患者费用因子分析

目的：探讨天津市城乡参保脑卒中住院患者费用构成及主要影响因子，为减轻患者经济负担，评价政策实施效果提供参考依据。方法调取天津市城乡居民医疗保险管理信息系统2010年1月至2012年12月于天津市三级医院就医的脑卒中城乡参保住院患者39500例，利用SPSS17.0进行数据录入和因子分析法分析。结果本次调查患者男性18364人，占总人数的46.49%，女性21136人，占总人数的53.51%；总体住院费用504353997.50元，平均住院费用12768.46元，平均住院天数11.32天，日均住院费用1127.96元。住院费用构成中，药品费占49.54%，检查费占18.26%，治疗费占16.22%，手术费占1.31%，床位费占3.76%，材料费占10.17%，输血费占0.09%，其他费用占0.65%。实际自付总金额为325285295.10元，其中政策性自付金额占总自付金额的68.37%，自付金额占总自付金额的31.63%；因子分析共提取8个因子，其中前两个因子的药品费和检查费的贡献率分别为42.018%、15.057%，累计贡献率为57.075%。结果表明影响天津市城乡参保脑卒中住院患者费用主要因子为药品费和检查费；天津市城乡居民基本医疗保险政策影响参保脑卒中患者住院费用。结论着力控制药品费，完善政策，缩小与城镇职工基本医疗保险的差距。

Factor analysis of costs of hospitalized patients with stroke who participated in urban and rural medical insurance in Tianjin

Objective To investigate the constitution and main factors of costs of hospitalized patients with stroke who participated in urban and rural medical insurance in Tianjin, in order to alleviate the financial burden on patients and provide reference for evaluating the effect of policy implementation. Methods Thirty-nine thousand and five hundred cases of hospitalized patients with stroke were drawn from medical insurance management information system of urban and rural residents in 2010 to 2012, using SPSS17. 0 and factor analysis. Results There were 21 136 female patients, which accounted for 53. 51% of all the stroke patients and more than male ones. The total hospitalization cost was 504 353 997. 50 yuan, the average hospitalization cost was 12 768. 46 yuan, the average length of hospitalization was 11. 32 days, and the average daily hospitalization cost was 1 127. 96 yuan. Of hospitalization expenses, drug costs accounted for 49. 54%, inspection fees 18. 26%, treatment costs 16. 22%, operation costs 1. 31%, bed fees 3. 76%, material costs 10. 17%, blood transfusion fees 0. 09%, others 0. 65%. The patients actual paid 325 285 295. 10 yuan, and the country paid 69. 37% of the costs. Drug costs and examination fee were primarily factors. The policies affected costs of hospitalized patients with stroke who participated in urban and rural medical insurance in Tianjin. Conclusion We should control drug costs, improve the policy, and narrow the gap between urban and rural medical insurance.