摘要
目的分析心脏起搏器植入患者住院费用构成及变化趋势,为减轻起搏器植入患者直接经济负担提供科学依据.方法收集上海市某三甲医院2017年5月1日-2019年6月30日出院的660例心脏起搏器植入患者的住院费用数据,采用灰色关联法和结构变动度分析住院总费用的关联程度、结构和变动情况.结果从灰色关联来看,与住院总费用关联度最高的是卫生材料费0.7961,其次是化验费0.3580和检查费0.3565,护理费0.3507和治疗费0.3506的关联度较小,分别排在第7和第9位;引起住院总费用结构变动最大的是卫生材料费50%,其次是化验费16.06%和检查费11.50%,累计贡献率达77.56%,2017年-2018年治疗费5.35%、护理费5.27%的结构变动贡献率较2018年-2019年0.34%、1.93%有较大幅度减少.结论卫生材料费是影响起搏器植入患者住院总费用的主要因素,体现医务人员劳动价值的收入项增幅不明显,建议进一步加强卫生材料使用管控,调整医疗服务价格;规范临床路径、建立诊疗规范体系;完善医保支付方式,加快推进疾病诊断相关分组和病种分值付费方式.
Objective To analyzes the composition and trend of hospitalization expenses of patients with pacemaker implantation,and provides scientific basis for reducing the direct economic burden of patients with pacemaker implantation.Methods The inpatient cost data of 660 patients with pacemaker implantation discharged from a tertiary-level hospital in Shanghai from May 1,2017 to June 30,2019 were collected,and the correlation degree,structure and change of total inpatient cost were analyzed by using the grey relevancy analysis and structural variation.Results From the perspective of gray correlation,the cost of sanitary materials(0.7961)has the highest degree of correlation with the total hospitalization cost,followed by the cost of laboratory tests(0.3580)and inspection fees(0.3565),and the degree of correlation between nursing costs(0.3507)and treatment costs(0.3506)Smaller,ranked 7 th and 9 th respectively;the largest change in the total hospitalization cost structure is the cost of sanitary materials(50%),followed by laboratory fees(16.06%)and inspection fees(11.50%),with a cumulative contribution rate of up to 77.56%,the contribution rate of structural changes in treatment expenses and nursing expenses has decreased significantly(5.35%and 5.27%in 2017-2018;0.34%and 1.93%in 2018-2019).Conclusion The cost of raw materials is the main factor affecting the total hospitalization cost of patients with pacemaker implantation.The income item reflecting the labor value of medical personnel does not increase significantly.It is suggested to further strengthen the control of the use of sanitary materials.Continue to adjust the prices of medical services;Standardizing clinical pathway and establishing diagnostic and treatment standard system;Improve medical insurance payment methods and accelerate the adoption of DRGs and DIP payment methods.
作者
朱乐兰
袁筱祺
冯运
高玮
Zhu Yuelan;Yuan Xiaoqi;Feng Yun;Gao Wei(Shanghai General Hospital of Nanjing Medical University,Shanghai 200080,China)
出处
《中国病案》
2021年第6期63-66,共4页
Chinese Medical Record
基金
上海交通大学中国医院发展研究院医院管理建设项目(CHDI-2019-B-14)
关键词
心脏起搏器
住院费用
灰色关联分析
结构变动度
Cardiacpacemaker
Hospital costs
Grey relevancy analysis
Degree of structural variation(DSV)
