参保脑卒中患者住院费用影响因素分析

目的 探讨参保脑卒中患者住院费用构成及其主要影响因素，为合理控制医保费用过快增长、完善医疗保障制度和减轻患者经济负担提供参考依据。方法 2015年5月，回顾性收集安徽省某三甲综合医院12 363例主要诊断为脑卒中的出院患者的病例资料，对患者的一般情况及住院费用构成进行描述性分析，采用单因素分析及多元线性逐步回归分析探讨住院费用的主要影响因素。结果 安徽省某三甲医院2005-2014年参保脑卒中患者例均住院费用为7 746.74元，例均住院费用呈逐年上升趋势（P<0.01）；参保脑卒中患者药品费、耗材费、检查费、治疗费、检验费、床位费、护理费等费用分别为4 736.82元（63.33%）、90.83元（12.20%）、590.00元（7.28%）、433.00元（5.82%）、453.80元（5.72%）、216.00元（2.94%）和132.00元（1.92%）；平均住院日为14.28 d，中位数为12 d；多元线性回归分析显示，住院日是参保脑卒中患者住院费用的首要影响因素，住院时间越久、药占比越高、疗效越差、入院Rankin评分越高、年龄越大、存在手术情况的参保脑卒中患者住院费用高于无上述情况的患者。结论 降低参保脑卒中患者住院费用的不合理增长应以合理缩短住院日、降低药占比为突破口，采取综合措施控制相关因素。

Influencing factors of hospitalization cost among stroke inpatients with medical insurance

Objective To study components and main influencing factors of hospitalization cost among stroke inpatients with medical insurance,and to provide evidences for reasonable control of hospitalization cost and improvement of medical insurance system.Methods Medical records of 12 363 stoke patients with medical insurance hospitalized in a tertiary hospital in Anhui province from 2005 through 2014 were collected retrospectively.The components and main influencing factors of hospitalization cost among the inpatients were analyzed with univariate factor analysis and multivariate linear regression analysis.Results The median of hospitalization cost for the inpatients during the period was 7 746.74 (RMB Yuan),with an annually increasing tendency (P<0.01); the items of the hospitalization cost included medication (median=4 736.82,median of percentage=63.33%),materials (90.83,12.20%),examination (590.00,7.28%),treatment (433.00,5.82%),laboratory test (453.80,5.72%),bedding (216.00,2.94%),and nursing care (132.00,1.92%).The average length of hospital stay was 14.24 days with a median of 12.0 days.Multiple linear regression analysis indicated that the length of hospital stay was the strongest factor affecting medical cost and the hospitalization cost was positively correlated with the length of hospital stay,proportion of drug expense,ranking score at the admission,age of the inpatient,and with operation treatment and inversely correlated with curative effect among the inpatients.Conclusion Shortening the length of hospital stay and decreasing drug fee reasonably may be effective measures to lower the unreasonably growing in hospitalization cost for stoke inpatients with medical insurance.