| 重庆市肺结核患者直接医疗费用及其影响因素分析 |
| |
| 引用本文： | 张婷,苏倩,吴成果,汪清雅,雷蓉蓉,陈健. 重庆市肺结核患者直接医疗费用及其影响因素分析[J]. 中国防痨杂志, 2021, 43(9): 910-915. DOI: 10.3969/j.issn.1000-6621.2021.09.010 |
| |
| 作者姓名： | 张婷 苏倩 吴成果 汪清雅 雷蓉蓉 陈健 |
| |
| 作者单位： | 400050.重庆市结核病防治所 |
| |
| 基金项目： | 重庆市科卫联合医学科研项目(2019MSXM095);重庆市科卫联合医学科研项目(2021MSXM142) |
| |
| 摘 要： | 目的 调查重庆市活动性肺结核患者的直接医疗费用情况,并分析其影响因素。方法 从《中国疾病预防控制信息系统》的子系统《结核病信息管理系统》中搜集重庆市41家区(县)级结核病定点医院2019年1—12月登记的新诊断为活动性肺结核患者(排除单纯肺外结核和利福平耐药肺结核患者)的病案信息,并与2019年1月1日至2020年5月31日重庆市46家市级和区(县)级结核病定点医疗机构的门诊和住院诊疗记录、收费和报销等诊疗信息和费用结算信息进行匹配,最终纳入已治愈或已完成疗程的11745例患者。采用单因素分析和多因素广义线性模型分析调查对象的直接医疗费用及相关影响因素。结果 11745例调查对象的直接医疗费用共计8385.6万元,其中,药品费用为3400.9万元(40.56%),检查费用为3205.3万元(38.22%),其他费用为1779.4万元(21.22%);每例调查对象的直接医疗费用中位数(四分位数)为4517.0(2144.0,8903.0)元。多因素广义线性模型分析显示,二级医院、三级医院、城镇医保职工、有并发症和住院治疗是增加普通活动性肺结核患者直接医疗费用的影响因素[直接医疗费用中位数(四分位数)分别为:4701.0(2262.0,9165.0)、5258.0(2198.0,11197.5)、6158.0(2960.0,11619.0)、6289.0(2658.0,11417.0)和10858.0(7544.0,16390.0)元;OR(95%CI)值分别为:1.299(1.062~1.437)、1.123(1.020~1.366)、1.240(1.114~1.379)、1.149(1.096~1.205)和3.115(3.012~3.226)]。结论 重庆市普通活动性肺结核患者直接医疗费用较高,高级别医疗机构、城镇医保职工、有并发症和住院治疗是影响费用增高的因素。应积极开展实行单病种付费医保政策,并规范二、三级结核病定点医院和对医保职工的诊疗行为。
|
| 关 键 词： | 结核 肺 费用 医疗 患病代价 因素分析 统计学 重庆市 |
| 收稿时间： | 2021-06-03 |
Analysis of direct medical costs and influencing factors of pulmonary tuberculosis patients in Chongqing |
| |
| ZHANG Ting,SU Qian,WU Cheng-guo,WANG Qing-ya,LEI Rong-rong,CHEN Jian. Analysis of direct medical costs and influencing factors of pulmonary tuberculosis patients in Chongqing[J]. The Journal of The Chinese Antituberculosis Association, 2021, 43(9): 910-915. DOI: 10.3969/j.issn.1000-6621.2021.09.010 |
| |
| Authors: | ZHANG Ting SU Qian WU Cheng-guo WANG Qing-ya LEI Rong-rong CHEN Jian |
| |
| Affiliation: | Chongqing Tuberculosis Control Institute, Chongqing 400050, China |
| |
| Abstract: | Objective To investigate the direct medical expenses of active pulmonary tuberculosis (PTB) patients in Chongqing and analyze the influencing factors. Methods Clinical data of PTB patients (excluded patients with simple extra-pulmonary tuberculosis and rifampicin-resistant tuberculosis) registered in 41 district/county level TB hospitals in Chongqing from January to December in 2019 were collected from the subsystem (Tuberculosis Information Management System) of the China Information System for Disease Control and Prevention, and match with the diagnosis, treatment and cost information (such as outpatient and inpatient records, charging and reimbursements, etc.) of TB medical institutions at the municipal and district/county level in Chongqing from January 1, 2019 to May 31, 2020. Finally, 11745 patients who had been cured or had completed the treatment were included. Single-factor analysis and multi-factor generalized linear model analysis were used to investigate the direct medical expenses and influencing factors. Results The total direct medical expenses of 11745 cases were 83856000 yuan, of which 34009000 yuan (40.56%) for drugs, 32053000 yuan (38.22%) for examinations, and 17794000 yuan (21.22%) for others. The median (quartiles) of direct medical cost per case was 4517.0 (2144.0, 8903.0) yuan. Multifactorial generalized linear model analysis showed that secondary hospitals, tertiary hospitals, workers with urban health insurance, complications and hospitalization were the influential factors that increased the direct medical costs of general PTB patients. The medians (quartiles) of the direct medical costs of these five factors are: 4701.0 (2262.0, 9165.0), 5258.0 (2198.0, 11197.5), 6158.0 (2960.0, 11619.0), 6289.0 (2658.0, 11417.0) and 10858.0 (7544.0, 16390.0)yuan, respectively; OR (95%CI) values are: 1.299 (1.062-1.437), 1.123 (1.020-1.366), 1.240 (1.114-1.379), 1.149 (1.096-1.205) and 3.115 (3.012-3.226), respectively. Conclusion The direct medical expenses of PTB patients in Chongqing were high. High-level medical institutions, workers with health insurance, complications and hospitalization were the influential factors that increased the direct medical costs. We should proactively develop and implement the medical insurance policy of single-disease payment should be promoted, second- and third-level TB hospitals and the treatment of employees with medical insurance should be regulated. |
| |
| Keywords: | Tuberculosis pulmonary Fees medical Cost of illness Factor analysis statistical Chongqing City |
|
| 点击此处可从《中国防痨杂志》浏览原始摘要信息 |
|
点击此处可从《中国防痨杂志》下载全文 |
|
