深圳市住院死亡患者医疗费用负担的影响因素研究——基于病案首页数据

目的：考察住院死亡患者医疗费用负担的影响因素。方法：使用2017—2021年深圳市西医医院住院死亡患者的病案首页数据，构建分位数回归模型，估计不同医疗费用水平下，年龄、性别、医疗付费方式等变量对医疗费用的影响。结果：在0.5分位数水平下，男性、年龄越低、三级医院就诊、疾病数量和住院天数越多的住院死亡患者医疗费用负担越大；随着分位数水平的提高，医疗保险支付对住院死亡患者医疗费用负担的影响由负向转为正向。结论：女性和高龄住院死亡患者的医疗费用负担更低；医疗保险参与可能促进了无效医疗与过度医疗行为的发生；罹患疾病数量的增加促进了住院死亡患者医疗费用负担。应当发展和完善临终关怀服务，促进死亡观念的转变，同时关注罹患多种疾病对住院死亡风险的影响。

A study on the influencing factors of the medical expense burden of hospitalized deaths in Shenzhen based on homepage data of medical records

Objective: To investigate the influencing factors of the medical expense burden of the hospitalized deaths. Methods: The quantile regression model was constructed using the homepage data of the medical records of the hospitalized deaths in Shenzhen Western Medical Hospital from 2017 to 2021 to estimate the impact of age, gender, medical payment methods and other variables on medical expenses under different medical expense levels. Results: At the 0.5 quantile level, the medical expense burden of the hospitalized deaths increased when patients were male, at a younger age, treated at tertiary hospitals, having multiple diseases and spending more days in hospital; With the growth of the quantile level, the impact of medical insurance payment on the medical expense burden of hospitalized patients shifted from negative to positive. Conclusions: The burden of medical expenses on female and the elderly hospitalized deaths is lower; Medical insurance participation might encourage occurrence of ineffective medical treatment and excessive medical treatment; The increase in the number of diseases has promoted the burden of medical expenses on hospitalized deaths. Hospice services should be developed and improved to promote a change in perceptions of death, while paying attention to the impact of multiple diseases on the risk of hospital death.