北京市医药分开综合改革前后脑梗死患者住院费用对比

目的分析对比某医院2016年1月1日-2018年12月31日脑梗死住院患者医药分开综合改革前后住院费用差异。方法采用卡方检验方法分析脑梗死住院患者医改前后性别、患者来源、付费方式和治疗方式的差异;T检验方法分析医改前后脑梗死住院患者各项费用对比差异;分层分析脑梗死住院患者的不同治疗方式在医改前后各项费用的差异。结果脑梗死住院患者医改前后例均费用分别为23259元和24442元,控制其他因素的影响,医改前后脑梗死住院患者费用没有差异(P=0.744),医改后脑梗死住院患者例均药费降低(P<0.001)、例均检查费增加(P=0.002)、例均材料费增加(P<0.001)和例均治疗费增加(P<0.001);分层分析不同治疗方式,脑梗死住院患者医改后例均费用内科治疗减少了877元(P=0.0.094),手术治疗增加了21545元(P=0.076),介入治疗增加了12863元(P=0.295),后二者的例均材料费增加了分别为15243元(P=0.037)和16907元(P<0.001)。结论脑梗死住院患者医药分开综合改革前后费用没有统计学差异,脑梗死介入治疗和手术治疗费用增加归因于材料费用增加。

Comparative study on Inpatient Cost with Cerebral Infarction Before and After Comprehensive Medical Reform in Beijing

Objective This study was to compare and analyze the cost difference of inpatients with cerebral infarction before and after the comprehensive reform of separation between medical and pharmaceutical services from January 1,2016 to December 31,2018.Methods The chi-square test method was used to analyze the differences in gender,source of patients,payment methods and treatment methods of inpatients with cerebral infarction before and after the medical reform.T test method was used to analyze the differences in expenses of inpatients with cerebral infarction before and after the medical reform.According to different treatment methods for inpatients with cerebral infarction.We analyzed the differences of expenses before and after the medical reform.Results The average cost of inpatients with cerebral infarction before and after the medical reform was 23,259 yuan and 24,442 yuan,respectively.Controlling the influence of other factors,there was no statistical difference in the cost of inpatients with cerebral infarction before and after the medical reform(P=0.744).The average drug cost of patients with cerebral infarction decreased(P<0.001),the average examination cost increased(P=0.002),the average material cost increased(P<0.001),and the average treatment cost increased(P<0.001)after the medical reform.Based on stratified analysis of different treatment methods after the medical reform of inpatients with cerebral infarction,the average cost of medical treatment was reduced by 877 yuan(P<0.0.094),surgical treatment increased by21,545 yuan(P=0.076),and interventional treatment increased by 12,863 yuan(P=0.295).The average material cost of the surgical treatment cases and interventional treatment cases increased by 15243 yuan(P=0.037)and 16907 yuan(P<0.001)respectively.Conclusion There was no difference in the cost before and after the comprehensive reform of separation of medical treatment for inpatients with cerebral infarction.The increase in the cost of interventional and surgical treatment of cerebral infarction was attributed to the increase in material costs.