不同医保支付模式下耐碳青霉烯类革兰阴性杆菌医院感染对直接医疗费用的影响

 目的 了解不同医保支付模式下耐碳青霉烯类革兰阴性杆菌(CRO)医院感染患者的直接医疗费用。方法 采用病例对照研究方法,选择某三甲医院2019年1月—2021年12月CRO医院感染患者为感染组,按条件1 ∶1 配比后筛选出对照组,采用中位数描述两组患者住院日数和住院费用等,采用秩和检验,分析不同支付模式下CRO医院感染的直接医疗费用。结果 共有75例CRO医院感染患者,为感染组;成功配对75例为对照组。感染组患者较对照组住院日数延长24.4 d,住院均次费用高10.4万元,日均住院费用高0.6万元,自费金额高7.1万元,抗菌药物费用高0.5万元,差异均有统计学意义(均P＜0.05)。不同支付类型的感染组患者与其对照组的住院均次费用比较,差异均有统计学意义(均P＜0.05)。其中,市级城镇职工组因感染较对照组增加的住院均次费用最多,为14.5万元;全自费组因感染较对照组增加住院均次费用12.2万元。城镇居民医保、省级城镇职工医保患者因感染较对照组增加的自付费用分别为5.5万、1.4万元,差异均有统计学意义(均P＜0.05)。省级城镇职工因感染较对照组增加日均住院费用0.3万元,差异有统计学意义(P=0.001)。结论 不同医保支付模式下,CRO感染患者的均次住院费用、平均住院日数、日均住院费用、人均自付金额均高于非感染患者,对市级城镇职工、农村合作医疗及全自费患者造成了沉重的经济负担。

Impact of carbapenem-resistant Gram-negative organism on direct medical expenses under different medical insurance payment modes

Objective To understand direct medical expenses of patients with healthcare-associated infection (HAI) due to carbapenem-resistant Gram-negative organism (CRO) under different medical insurance payment modes.Methods Case control study was adopted, patients with CRO HAI in a tertiary first-class hospital from January 2019 to December 2021 were selected as infection group, after the 1 ∶1 conditional matching, control group was screened, length of hospital stay and average hospitalization expense of two groups of patients were described by median, direct medical expense of CRO HAI under different payment modes was analyzed by rank sum test.Results There were 75 CRO HAI patients in infection group; 75 cases were successfully matched as control group. Compared with control group, length of hospital stay in patients in infection group extended by 24.4 days, the ave-rage hospitalization expense increased by 104 000 Yuan, the average daily hospitalization expense increased by 6 000 Yuan, the self-paid expense amount increase by 71 000 Yuan, and expense of antimicrobial agents increased by 5 000 Yuan, differences were all significant (all P<0.05). The average hospitalization expense in patients in infection group with different payment modes were significantly different from that of control group (all P<0.05). The average hospitalization expense due to infection of municipal employee group increased most than that of control group, which was 145 000 Yuan; compared with control group, the average hospitalization expense due to infection of all self-paid group increased by 122 000 Yuan, the self-paid expense due to infection of patients with municipal residents medical insurance and provincial medical insurance increased by 55 000 Yuan and 14 000 Yuan respectively, with a significant difference (both P<0.05), the average daily hospitalization expense due to infection of provincial employees increased by 3 000 Yuan, differences were all significant (all P=0.001).Conclusion Under diffe-rent medical insurance payment modes, the average expense of each hospitalization, average length of hospital stay, average daily hospitalization expense and self-paid amount of CRO-infected patients are higher than those of non-infected patients, which cause a heavy economic burden on municipal employees, rural cooperative medical care and all self-paid patients.