摘要
目的调查乙型病毒性肝炎(乙肝)患者的门诊直接经济负担及影响因素,为进一步完善医疗保障政策提供依据。方法采用时间阶段连续病例整群抽样方法,选择2012年8—12月于江苏省重大传染病综合防治示范区县级医疗机构门诊就诊的乙肝患者为调查对象,通过问卷调查乙肝患者的门诊直接经济负担,采用SPSS 19.0统计软件对乙肝患者的一般资料、次门诊费及年门诊费进行单因素及多因素线性回归分析。结果本调查共纳入乙肝患者436例,次门诊费平均670.0元,年门诊费平均12 714.0元。不同婚姻状况患者的检查费、次门诊费合计,不同经济状况患者的挂号费、检查费,不同医疗保障类型患者的挂号费、检查费,不同疾病类型患者的门诊费合计,抗病毒治疗和非抗病毒治疗患者的药品费、次门诊费合计比较,差异均有统计学意义(P<0.05)。不同医疗保障类型患者年门诊费用中自付费比例间差异有统计学意义(χ2=49.307,P=0.000)。多因素线性回归分析显示,药品费、检查费、抗病毒治疗是次门诊费的影响因素;抗病毒治疗、次门诊费、年门诊次数、疾病类型是年门诊费的影响因素。结论乙肝患者门诊直接经济负担较大,抗病毒治疗加重了患者的经济负担;现行基本医疗保障制度对于门诊经济风险的分担效果有限,应将乙肝患者门诊抗病毒治疗纳入医疗保险统筹支付,通过早期治疗延缓疾病进展,从而降低社会负担。
Objective To study the outpatient direct costs of viral hepatitis B （HBV） patients and its influencing factors, to provide evidence for perfect medical security policy. Methods From August and December 2012, using time stage continuous sampling method, conducted a survey of direct economic burden of HBV outpatients in model regions for major infectious disease prevention and control in Jiangsu Province of China. SPSS 19.0 was used to do univariate and multiple linear regression analysis on the general data, once outpatient charges and yearly outpatient charges. Results A total of 436 HBV patients were enrolled, once outpatient charges was 670.0 yuan, yearly outpatient charges was 12 714.0 yuan. There was significant difference in fees of registration, inspection between patients in different marital status, between those in different economic status, between those having different types of Medicare, in total registration fees between those with different types of diseases, in total fees of drugs and registration between those having antiviral therapy and those not having antiviral therapy （P 〈 0. 05 ） . There was singificant difference in percentage of self - pay costs in annual registration fees between patients having different Medicares （x2 = 49. 307, P = 0. 000）. Multivariate linear regression analysis showed that fees of drugs and inspection, antiviral therapy were influencing factors of once outpatient charges; antiviral therapy, once outpatient charges, times of outpatient and disease types were influencing factors of yearly outpatient charges. Conclusion The direct economic burden of HBV patients is heavy, that of the patients having antiviral therapy. The current basic medical insurance system is not enough for outpatient economic risk. The outpatient antiviral therapy of HBV patients should be brought into health insurance fund payment to delay disease progression, thus reducing the social burden.
出处
《中国全科医学》
CAS
CSCD
北大核心
2014年第11期1293-1296,共4页
Chinese General Practice
基金
国家科技重大专项"江苏省防治艾滋病
病毒性肝炎和结核病等重大传染病规模化现场流行病学和干预研究"项目(2011ZX10004902)
江苏省疾病预防控制中心科教兴业基金项目"慢性乙肝患者规范治疗筹资模式的建立和验证研究"(JKRC2011020)
