江苏省高邮市送桥中心卫生院2010年住院疾病与费用构成调查

目的调查2010年江苏省高邮市送桥中心卫生院住院疾病构成及费用情况,了解当地疾病负担,为进一步研究提供基线数据。方法收集2010年住院病例资料。根据国际疾病分类编码(ICD-10)标化出院记录的第一诊断并系统归类。用Microso Excel 2003和SPSS 13.0等软件描述性分析住院患者情况、出院诊断,医疗费用及其病种、年龄和性别分布、费用报销情况等。结果①2010年送桥中心卫生院住院病例1?036人次,男女性别比约1.0(50.7%vs.49.3%);②住院系统疾病共17类,前5类疾病依次为呼吸、消化、肿瘤、循环及损伤中毒和外因的某些其他后果疾患,累计构成比81.2%;③前15位疾病依次是肺炎、骨折、恶性肿瘤、良性肿瘤、急性支气管炎、脑梗死、高血压、急性阑尾炎、肺气肿、胆囊结石伴胆囊炎、腹股沟疝、冠心病、糖尿病、慢支炎及浅表损伤;④肺炎和急性支气管炎患者年龄均主要集中于≥65岁和<5岁;⑤慢性病从35岁开始呈随年龄增大而增加的趋势,≥65岁者慢性病发病最多;急性病发病主要集中在≤15岁和≥55岁;平均住院日、次均总住院费用、自付费用均为慢性病高于急性病(13.8天vs.9.9天;$3082.1 vs.$2614.5;$416.5 vs.$370.6);⑥次均住院日和次均住院费用均远高于全国乡镇卫生院的平均水平(11.6天vs.5.2天,$3001.4 vs.$1004.6);⑦次均总补偿费用和自付费用占总住院费用比例均达44%～57%;新农合补偿占总补偿金额比例均达99%以上,但医疗救助占总补偿金额比例不足2%。结论①江苏省高邮市送桥中心卫生院2010年住院病例前3位系统疾病是呼吸、消化及肿瘤,急性病多集中于肺炎和骨折。②青少年和老年人为疾病负担最重的人群,35岁以上年龄段的急慢性病患者均呈显著增加趋势。③该院次均住院日和次均住院费用均远高于全国乡镇卫生院的平均水平;④该院患者住院费用以新农合补偿为主,但个人自付医药费用比例较高,负担仍较重,需逐步调整新农合补偿政策。

A Survey on Inpatient Disease Constitution and Hospitalization Expenses in Songqiao Central Township Health Center of Gaoyou City,Jiangsu Province in 2010

Objective To investigate the disease constitution and hospitalization expenses in Songqiao Central Township Health Center（SqC） in Gaoyou City of Jiangsu Province in 2010,so as to provide the baseline data of disease burden for further study.Methods The inpatient records of SqC in 2010 were collected.The first discharge diagnoses were classified according to the International Classification of Disease 10（ICD-10）.The general information of the inpatients,discharge diagnosis,hospitalization expenses,disease category,age,gender,and reimbursement of expenses were described and analyzed by using Microsoft Excel 2003 and SPSS 13.0 software.Results a） The total number of inpatients was 1036 in 2010,and the gender ratio was about 1.0（50.7% vs.49.3%）;b） The disease spectrum included 17 categories.The cumulative percents of the top 5 systematic diseases were 81.2%,including the respiratory,digestive,neoplasm,circulatory diseases,and injury,poisoning external causes;c） The top 15 diseases were pneumonia,fracture,malignant neoplasm,benign neoplasm,acute bronchitis,cerebral infarction,hypertension,acute appendicitis,emphysema,cholecystolithias accompanied with cholecystitis,inguinal hernia,coronary heart disease,diabetes mellitus,chronic bronchitis and superficial injury;d） The patients suffering from pneumonia and acute bronchitis were mainly over 65 years old and younger than 5;e） The number of chronic diseases significantly increased with age,especially after the age of 35 years old,and reached the peak at the age over 65 years old;while the acute diseases were mainly distributed at the age younger than 15 yeas old and older than 65 years old.The average length of stay,the total hospitalization and out-of-pocket expenses per capita of the chronic diseases were more than those of the acute ones（13.8 days vs.9.9 days,$ 3？082 vs.$ 2？615;$ 417 vs.$ 371,respectively）;f）The length of stay and total hospitalization per capita were quite higher than the other township health centers（11.6 days vs.5.2 days,$ 3？001.4 vs.$ 1？004.6）;and g） Both of the total reimbursement and out-of-pocket expenses per capita accounted for 44%-57% of the total hospitalization expenses.Among the total reimbursement,the payment from New Cooperative Medical Scheme（NCMS） accounted for over 99%,while that from Medical Aid Scheme only accounted for less than 2%.Conclusion a） The top 3 systematic diseases of SqC are seen in respiratory system,digestive system and neoplasm.The acute diseases are mainly pneumonia and fracture;b） The number of acute or chronic diseases increases significantly with age,especially after 35 years old.Both adolescents and the aged suffer from the heaviest burden of diseases;c） The average length of stay and hospitalization expenses pre capita of SqC are much higher than those of the other township health centers;and d） NCMS is the major source of reimbursement.However,the proportion of out-of-pocket expenses and the burden of diseases are still very high and heavy.Thus the policy of NCMS needs to be adjusted step by step in future.