2013-2017年我国四种恶性肿瘤住院费用水平及结构变动度分析

背景　恶性肿瘤给家庭、社会带来了沉重的医疗、经济负担,极易导致部分家庭“因病致贫”或放弃治疗,目前相关研究多集中于单一病种、分散地域的研究,仍缺乏对于全国范围与多病种恶性肿瘤住院费用变化及结构构成的考量。目的　分析2013-2017年我国4种恶性肿瘤住院费用水平以及影响住院费用的主要项目和结构变动情况,为控制医疗费用上涨、深化新医改提供参考依据。方法　本研究数据来源于《2014中国卫生和计划生育统计年鉴》《2015中国卫生和计划生育统计年鉴》《2016中国卫生和计划生育统计年鉴》《2017中国卫生和计划生育统计年鉴》以及《2018中国卫生健康统计年鉴》,样本跨度为2013-2017年。统计“30种疾病人均住院费用”中的胃恶性肿瘤、肺恶性肿瘤、食管恶性肿瘤以及膀胱恶性肿瘤的数据,4种恶性肿瘤的人均住院费用包括药费、检查费、治疗费、手术费和手术材料费。2019年4-8月,采用结构变动度法分析我国2013-2017年4种恶性肿瘤的住院费用的结构变动情况〔结构变动值（VSV）、结构变动度（DSV）、结构变动贡献率〕。结果　2013-2017年,4种恶性肿瘤的人均住院费用逐年上升,其中胃恶性肿瘤的人均住院费用始终最高,且肺恶性肿瘤的人均住院费用上升幅度最大。2013-2017年,在4种恶性肿瘤住院各项费用的占比中,药费占比最高且总体逐年下降。从4种恶性肿瘤住院各项费用的实际变化来看,药费在2013-2014年有所上升,2014-2017年逐年下降;检查费在2013-2014年下降,2014-2017年缓慢上升;手术费与手术材料费在2013-2017年逐年上升。2013-2017年,在4种恶性肿瘤住院各项费用中均是药费的VSV最大;4种恶性肿瘤药费、检查费的VSV均呈负向变化,手术费和手术材料费的VSV均呈正向变化,治疗费的VSV增减均不明显。2013-2017年,4种恶性肿瘤住院费用的DSV从大到小依次为肺恶性肿瘤、胃恶性肿瘤、食管恶性肿瘤、膀胱恶性肿瘤。2013-2017年,4种恶性肿瘤住院各项费用中均是药费的结构变动贡献率最大,治疗费的结构变动贡献率最小;除药费外,胃恶性肿瘤、肺恶性肿瘤住院各项费用中均是手术材料费和手术费的结构变动贡献率次之,食管恶性肿瘤住院各项费用中手术费、检查费的结构变动贡献率次之,膀胱恶性肿瘤住院各项费用中检查费、手术材料费的结构变动贡献率次之。结论　2013-2017年我国4种恶性肿瘤手术费的结构变动贡献率虽然较为理想,但药费、治疗费仍是住院费用结构的重点调整对象;同时为有效降低恶性肿瘤的人均住院费用,应当加强控制手术材料费与检查费;而胃恶性肿瘤与肺恶性肿瘤患者的疾病经济负担严重,若要缓解应加强疾病的早期预防与住院费用管控。

Hospitalization Cost and Its Structural Variation for Four Kinds of Malignant Tumors in China from 2013 to 2017

Background　Malignant tumors have brought a heavy medical and economic burden to the family and society,which is easy to cause some families falling into poverty due to illness or giving up treatment.Current studies about tumors mostly focus on single tumor or a region.And hospitalization costs and their structural variation of multiple tumors have been rarely studied at the national level.Objective　To analyze the hospitalization costs of four kinds of malignant tumors in China from 2013 to 2017,as well as the main items and structural changes that affect the hospitalization expenses,so as to provide a reference for controlling the increase of medical expenses and deepening the medical reform.Methods　The data were collected from China's Health and Family Planning Statistical Yearbook（2014—2017）and China Health Statistics Yearbook 2018,involving samples collected from 2013 to 2017.The data of gastric,lung,esophageal and bladder malignant tumors in "30 kinds of diseases per capita hospitalization medical expenses" were counted,in which per capita hospitalization cost includes drug cost,examination fee,treatment cost,operation cost and surgical material cost.Structural variation analysis was performed during April to August 2019 to analyze the structural variation〔value of structural variation（VSV）,degree of structural variation（DSV）,and contribution rate of DSV to structural variation〕of hospitalization costs of these 4 tumors.Results　From 2013 to 2017,the per capita hospitalization cost for 4 tumors increased year by year,among which the per capita hospitalization cost of gastric malignant tumors was always the highest,and that of lung malignant tumors increased the most.During this period,drug cost accounted for the greatest percentage of the hospitalization cost for these 4 tumors,but decreased year by year in general.Specifically,analyzing the changes of the 5 components of hospitalization cost showed that drug cost increased between 2013 and 2014,but decreased between 2014 and 2017 year by year.After the decline from 2013 to 2014,the cost of examination increased slowly from 2014 to 2017,but the cost of operation and surgical materials increased year by year from 2013 to 2017.In 2013—2017,among the 5 components of hospitalization cost for 4 tumors,drug cost had greatest VSV;the VSV of both drug cost and examination fee showed negative changes,and that of operation cost and surgical material cost showed positive changes,while treatment cost showed no significant changes.From 2013 to 2017,the DSV of hospitalization cost for four kinds of malignant tumors from top to bottom was lung malignant tumor,gastric malignant tumor,esophageal malignant tumor and bladder malignant tumor.During this period,the contribution rate of DSV of drug cost to structural variation of hospitalization cost for these tumors was largest,while that of treatment cost was smallest.The components with the second highest contribution rates of DSV to structural variation of hospitalization cost were operation cost and surgical material cost for gastric and lung malignant tumors,and were operation cost and examination fee for esophageal malignant tumor,and were examination fee and surgical material cost for bladder malignant tumor.Conclusion　Although contribution rate of DSV of operation cost of four kinds of malignant tumors in China from 2013 to 2017 is ideal at present,drug cost and treatment cost are still the key adjustment objects of cost structure.At the same time,the control of surgical material cost and examination fee should be strengthened in order to effectively reduce the per capita hospitalization cost.However,patients with gastric cancer and lung cancer have a serious economic burden of disease,so early prevention and cost control should be strengthened if relief is to be achieved.