高血压患者住院费用及其影响因素研究

目的研究高血压患者住院费用及影响因素。方法利用秩和检验比较住院费用的分布特征;应用递归系统模型分析住院费用的影响因素。结果乡镇卫生院患者次均住院费用为2537.87元,其中药费占比最高(75.65%);三级医院的次均住院费用为6691.17元,其中检查化验费占比最高(44.77%)。递归系统模型分析显示:疾病严重程度和城镇居民医保对住院费用既有直接影响又有间接影响;城镇职工医保和新农合等指标对住院费用只有间接影响;年龄、住院天数、医院级别和是否手术对总费用只存在直接效应。结论缩短住院天数、规范药品使用和避免不合理的检查化验、完善医疗保险政策可以有效控制医疗费用,减轻高血压患者的负担。     

住院费用影响因素分析的递归系统模型

以病情及有关社会因素为外生变量，住院天数和住院费用为内生变量，经变量筛选后，建立递归系统的联立方程，对住院费用的影响因素进行定量分析．模型拟合结果，Ｘ２拟合优度检验Ｐ＝０．８７８，拟合优度指数０．９９２，分析效果满意．     

慢性阻塞性肺疾病患者住院费用影响因素递归系统与结构方程模型分析

目的慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)给患者带来沉重的经济负担,已成为全球面临的重大公共卫生问题。预计至2020年COPD将成为全球第3位致死原因。中国每年因COPD死亡的人数128万。本研究通过对甘肃省兰州市2013-2016年COPD患者住院费用进行分析,对患者住院费用增长主要因素进行定量评价,为相关部门优化卫生费用结构、建立更加完善的卫生资源控制机制提供依据。方法将数据经过预处理后使用递归模型与结构方程模型方法对数据进行分析。结果通过递归系统模型(recursive system model,RSM)最后得出医院等级对于住院费用影响总效应为0.568。在递归系统模型中医院等级影响综合医疗服务费、诊断费与药费总效应分别为0.247、0.587与0.532,医院等级均排在各分析方法影响因素的首位。在递归方程模型中是否手术和入院途径影响因素的总效应分别0.208和-0.075。结构系统模型中(structural equation model,SEM)是否手术影响各部分住院费用的总效应仍然排在前列,其影响综合服务费、诊断费和药费的总效应分别为-0.133、-0.128和0.025 6。入院途径对综合医疗服务费与诊断费的总影响效应分别为-0.324和0.120。结论影响COPD患者住院费用的最主要因素为医院等级、是否手术与入院途径,同时住院天数与职业对住院总费用也产生一定影响。     

病种住院费用递归系统模型的多因素分析

本文以某医院１９９５年１５种疾病的住院例为研究样本，将病情及有关社会学因素作为外生变量，住院天数和住院费用为内生变量，针对单病种建立住院费用分析的递归系统模型，对住院费用的直接影响，间接影响及总影响进行了多因素分析，研究结果表明，不同病种的疾病特征不同，导致费用的差异较大，许多多生变量对住院的影响是通过住院天数间接产生的，不只限于直接效应。     

医保病人医疗费用相关分析

目的:通过对医疗保险病人的医疗费用分析,为医疗费用的合理控制提供科学依据。方法:对某三级甲等医院2005年全年医疗保险病人与公费、自费病人的门诊、住院费用及其费用构成进行对比研究;并采用逐步回归法寻找影响医疗保险病人住院费用高低的主要因素。结果:医疗保险病人门诊和住院总费用明显高于公费和自费病人,且医保病人各项费用中以药费所占比例最高;影响医保病人住院费用的主要影响因素为住院日和手术次数。结论:医院应在有效控制病人住院日的同时,控制药费的增长,以达到控制医疗费用合理增长。     

某市糖尿病微血管并发症老年患者住院费用分析

目的通过对某市2013—2016年糖尿病微血管并发症的三类病变糖尿病性肾病变、糖尿病性视网膜病变和糖尿病性周围神经病变的老年患者住院费用构成及影响因素分析,了解与住院费用相关的各种影响因素,为卫生部门有效控制住院费用的不合理增长提供参考依据。方法运用新灰色关联法分析住院费用中的每个单项费用与住院总费用的关联程度,然后运用递归模型分析住院费用的主要影响因素。结果新灰色关联度显示,糖尿病微血管并发症的老年患者总住院费用的关联前三位的为药费、综合医疗服务费和诊断费,其关联度为1.000 000、0.936 451和0.911 078。递归系统模型分析显示,老年患者住院费用总效应由大到小前五位为住院天数(0.645)、急诊(-0.215)、三级医院(0.212)、全自费(-0.198)和糖尿病性肾病变(0.132)。结论老年糖尿病视网膜患者次均住院费用较糖尿病肾病患者和糖尿病周围神经变患者高,患者经济负担较重,可以通过缩短不合理住院天数、降低药费、优化医保付费方式等措施有效控制住院费用。     

某院2011-2013年肿瘤病人住院费用的影响因素分析

目的分析肿瘤病人的住院费用,以期为卫生决策部门和医疗机构提供数据决策支持。方法对某院2011-2013年间出院的肿瘤病人住院费用的影响因素进行分析。结果肿瘤病人费用中以西药费为主要费用,占总费用的43.91%。住院时间长、有手术、抢救次数多、年龄大、有院内感染、出院有多个诊断、死亡及自费的病人是肿瘤病人住院费用高的正向影响因素。结论控制西药费,降低平均住院日,减少医院感染,健全社会保障系统是减轻肿瘤病人和社会负担的重要方法。     

某院2011-2013年肿瘤病人住院费用的影响因素分析北大核心CSCD

目的分析肿瘤病人的住院费用,以期为卫生决策部门和医疗机构提供数据决策支持。方法对某院2011-2013年间出院的肿瘤病人住院费用的影响因素进行分析。结果肿瘤病人费用中以西药费为主要费用,占总费用的43.91%。住院时间长、有手术、抢救次数多、年龄大、有院内感染、出院有多个诊断、死亡及自费的病人是肿瘤病人住院费用高的正向影响因素。结论控制西药费,降低平均住院日,减少医院感染,健全社会保障系统是减轻肿瘤病人和社会负担的重要方法。     

基于信息熵的决策树在结核病人住院费用分析中的应用

目的 探讨基于信息熵的决策树在结核病人住院费用分析中的应用. 方法 采用基于信息熵的决策树C4.5算法建立结核病人住院费用分析模型. 结果 决策树C4.5算法从20个变量中筛选出影响病人住院费用的有意义的14个因素并对其重要性进行排序;产生清楚易懂可用于预测的决策规则;建立预测模型,模型分类符合率为:训练集76.58%,验证集77.31%,测试集77.95%. 结论 决策树C4.5算法建立的模型效果较好,可应用于结核病人住院费用影响因素的分析及费用预测.     

联合卒中单元对脑卒中患者运动及生活能力的影响

目的：探讨联合卒中单元对脑卒中患者运动及生活能力的影响。方法：选90例脑卒中为卒中单元组，去年同期88例脑卒中常规治疗为非卒中单元组，比较临床指标、FMA量表评分、ADL指数。结果：卒中单元组平均住院天数明显缩短，住院费用未见明显增加，治愈率提高5％，死亡率下降1％。结论：联合卒中单元可促进脑卒中患者的运动功能及日常生活能力的提高。     

平均住院日影响因素实证分析

目的：研究平均住院日的影响因素及作用强度,为中国医院合理利用医疗资源提供参考依据。方法：以2003年北京市6所三甲医院的100 259个住院病人的病案首页数据为研究对象,结合Anderson模型,运用负二项回归对住院日的影响要素进行实证分析。结果：前定变量中除了婚姻状况外,其他前定变量、使能变量、需要变量对平均住院日都有显著性影响。敏感度分析结果显示了较好的稳健性。结论：医院在制定降低平均住院日策略时需要考虑前定变量、使能变量、需要变量这些因素的影响。     

单病种费用影响因素的通径分析

目的 分析单病种费用的影响因素,为今后费用控制提供依据。方法 根据指标间有层次结构的特点,以胆囊结石伴慢性胆囊炎为例,建立了通径分析模型。结果 清晰表明了医院指标间复杂的层次关系,并列出各指标通过多种途径影响住院费用的直接效应和间接效应。结论 通径分析可用于解决变量间复杂的层次结构关系,值得推广。     

2014—2016年齐齐哈尔市脑梗死住院患者直接医疗费用调查

目的：分析脑梗死患者的住院费用结构特征及其影响因素,为控制医疗费用的快速增长、合理利用卫生资源及制定补偿标准提供数据支持。方法：收集2014年1月-2016年12月齐齐哈尔医学院附属第三医院脑梗死住院患者病例首页和费用结算资料2214份,对其基本信息进行一般性统计描述,并采用多元逐步回归分析法对住院费用的变化趋势和影响因素进行分析。结果：脑梗死患者住院人数,住院费用均呈现每年递增的趋势,所占比例最高的为药物。付费方式、入院病情、地区类型、住院天数、药占比是影响住院费用重要因素。结论：控制患者住院天数,药物费用是减少脑梗死住院患者费用的主要措施。     

Cost analysis of home monitoring in lung transplant recipients

OBJECTIVES: The University of Minnesota has maintained a home monitoring program for over 10 years for lung and heart-lung transplant patients. A cost analysis was completed to assess the impact of home monitoring on the cost of post-transplant medical care. METHODS: Clinical information gathered with the monitoring system includes spirometry, vital signs, and symptom data. To estimate the impact of this system on medical costs, we completed a retrospective analysis of the effects of home monitoring on the cost of post-lung transplant medical care. The cost analysis used multivariate linear regression with inpatient, outpatient, and total medical care costs as the dependent variables. The independent variables for the regression include home monitoring adherence, underlying disease, ambulatory diagnostic group mapping variables, transplant type, and patient demographics. RESULTS: The multivariate regression of the overall cost results predicts a 52.4 percent reduction in total costs with 100 percent patient adherence; this rate includes a 72.24 percent reduction in inpatient costs and a 46.6 percent increase in outpatient costs. The actual first year average patient adherence was 74 percent. CONCLUSIONS: Adherence to home monitoring increases outpatient costs and reduces inpatient costs and provides an overall cost savings. The break-even point for patient adherence was 25.28 percent, where the net savings covered the cost of home monitoring. This is well within the actual first year adherence rates (74 percent) for subjects in the lung transplant home monitoring program, providing a net savings with adherence to home monitoring.     

Advances in Value-Based Healthcare by the Application of Time-Driven Activity-Based Costing for Inpatient Management: A Systematic Review

ObjectivesImplementation of value-based initiatives depends on cost-assessment methods that can provide high-quality cost information. Time-driven activity-based costing (TDABC) is increasingly being used to solve the cost-information gap. This study aimed to review the use of the TDABC methodology in real-world settings and to estimate its impact on the value-based healthcare concept for inpatient management.MethodsThis systematic review was conducted by screening PubMed/MEDLINE and Scopus databases following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, including all studies up to August 2019. The use of TDABC for inpatient management was the main eligibility criterion. A qualitative approach was used to analyze the different methodological aspects of TDABC and its effective contribution to the implementation of value-based initiatives.ResultsA total of 1066 studies were retrieved, and 26 full-text articles were selected for review. Only studies focused on surgical inpatient conditions were identified. Most of the studies reported the types of activities on a macrolevel. Professional and structural cost variables were usually assessed. Eighteen studies reported that TDABC contributed to value-based initiatives, especially cost-saving findings. TDABC was satisfactorily applied to achieve value-based contributions in all the studies that used the method for this purpose.ConclusionsTDABC could be a strategy for increasing cost accuracy in real-world settings, and the method could help in the transition from fee-for-service to value-based systems. The results could provide a clearer idea of the costs, help with resource allocation and waste reduction, and might support clinicians and managers in increasing value in a more accurate and transparent way.     

Inpatient and outpatient health care demand in Cairo,Egypt

This paper uses the results of a household survey conducted in Cairo, Egypt in 1992 to examine the factors that influence the demand for inpatient and outpatient health services. Multi-stage discrete choice models of the demand for health care, which identify the importance of individual, household, and facility level variables on each treatment decision, are estimated separately for outpatients and inpatients. Consumers are assumed to decide whether to seek any treatment and then choose between three categories of providers: a large public hospital (Embaba Hospital), all other public providers, and private/charitable providers. The results confirm that more affluent consumers prefer the higher cost, higher quality private and charitable hospitals. Age, sex, education, and insurance are also found to strongly impact the use of medical services. The results are suggestive but do not conclusively show that inpatient care is less price responsive than outpatient care. Price responsiveness of inpatient and outpatient demand are imprecisely estimated because price is highly correlated with quality, and the available data on facility quality do not permit us to adequately control for quality variations across facilities.     

深圳市龙岗区农村合作医疗住院病人单病种费用分析

目的以1992—2003年深圳市龙岗区合作医疗的住院病人为样本，对住院病人进行单病种费用分析．着重分析了影响前10种疾病住院费用的主要因素．为控制住院费用提供科学依据。方法采用描述性分析和多重回归对其住院费用进行分析。结果冠心病、高血压、胃肠炎、上呼吸道感染、脑梗塞、肺炎、支气管炎和白内障等是影响龙岗区农村人口健康的主要问题，报销费用和住院天数是影响住院费用的主要因素。结论报销制度从单纯医疗型向预防保健综合型转变．实行按病种定额报销和按比例报销相结合是未来合作医疗发展可供借鉴的模式。     

How well do diagnosis-related groups for appendectomy explain variations in resource use? An analysis of patient-level data from 10 European countries

Appendectomy is a common and relatively simple procedure to remove an inflamed appendix, but the rate of appendectomy varies widely across Europe. This paper investigates factors that explain differences in resource use for appendectomy. We analysed 106,929 appendectomy patients treated in 939 hospitals in 10 European countries. In stage 1, we tested the performance of three models in explaining variation in the (log of) cost of the inpatient stay (seven countries) or length of stay (three countries). The first model used only the diagnosis-related groups (DRGs) to which patients were coded, the second model used a core set of general patient-level and appendectomy-specific variables, and the third model combined both sets of variables. In stage two, we investigated hospital-level variation. In classifying appendectomy patients, most DRG systems take account of complex diagnoses and comorbidities but use different numbers of DRGs (range: 2 to 8). The capacity of DRGs and patient-level variables to explain patient-level cost variation ranges from 34% in Spain to over 60% in England and France. All DRG systems can make better use of administrative data such as the patient's age, diagnoses and procedures, and all countries have outlying hospitals that could improve their management of resources for appendectomy.     

Climate change and vector-borne diseases: an economic impact analysis of malaria in Africa

A semi-parametric econometric model is used to study the relationship between malaria cases and climatic factors in 25 African countries. Results show that a marginal change in temperature and precipitation levels would lead to a significant change in the number of malaria cases for most countries by the end of the century. Consistent with the existing biophysical malaria model results, the projected effects of climate change are mixed. Our model projects that some countries will see an increase in malaria cases but others will see a decrease. We estimate projected malaria inpatient and outpatient treatment costs as a proportion of annual 2000 health expenditures per 1,000 people. We found that even under minimal climate change scenario, some countries may see their inpatient treatment cost of malaria increase more than 20%.     

Diagnosis related groups and variations in resource use for child delivery across 10 European countries

Childbirth is one of the main causes of hospitalisation for women, accounting for about 5% of hospital activity in most Organisation for Economic Co-operation and Development countries. We analysed the factors that explain variations in resource use for child delivery in ten European countries. We compared the performance of three models for explaining the variations in resource use (log cost or length of inpatient stay) at patient and hospital level. The first model used only the DRGs to which child deliveries were coded (M(D) ), the second used a set of 'patient-level' and delivery specific explanatory variables (M(P) ), and the third model combined both sets of variables (M(F) ). Countries vary both in the number of DRGs and the criteria used to classify cases of child delivery (range: 3-8) and in the percentage of deliveries classified as 'delivery without complication' (range: 53-90%). The capacity of DRGs and patient level variables to explain cost variation for child birth ranges from 48% in Sweden to over 70% in Spain. There is room for improving current DRG classification in most countries, but this does not necessary imply multiplying the groups and/or complicating criteria. Countries with a higher number of DRGs do not always perform better.