摘要
目的:分析DRG支付方式改革背景下脑血管病介入治疗患者住院费用变化及其影响因素,为合理控制脑血管病介入治疗患者住院费用提供参考。方法:收集2020年1月1日至2024年12月31日山西省某三级甲等医院865例脑血管病介入治疗患者病案基本信息和各项住院费用明细,运用结构变动度法分析次均住院费用与各项费用间的结构变动情况;采用中断时间序列分析2020—2024年脑血管病介入治疗患者住院费用变化趋势,采用单因素分析、广义线性回归模型分析DRG实际运行后脑血管病介入治疗患者住院费用影响因素。结果:次均住院费用总体结构变动度为12.05%,结构变动贡献率最大的项目为卫生材料费(43.09%)和药品费(29.77%),累计贡献率为72.86%。ITSA结果显示,脑血管病介入治疗患者住院费用整体明显下降,且在DRG实际运行阶段平均每月下降154.82元。广义线性回归结果显示治疗部位、统筹区、住院天数、入院状态是脑血管病介入治疗患者住院费用的影响因素。结论:DRG支付改革能够有效控制患者次均住院费用,但仍需进一步优化费用结构。医院应考虑治疗部位、统筹区和入院状态对费用的影响,合理控制住院天数,从而进一步降低脑血管病介入治疗成本与患者经济负担。
Objective:The paper analyzes the changes and influencing factors of hospitalization expenses in patients with cerebrovascular disease undergoing interventional therapy under the background of DRG payment reform,and provides references for reasonable control of hospitalization expenses in patients with cerebrovascular disease undergoing interventional therapy.Methods:The basic medical records and the details of hospitalization expense of 865 patients with cerebrovascular disease undergoing interventional treatment in a Grade-III hospital from January 1,2020 to December 31,2024 in Shanxi Province were collected.,The structural changes between the average hospitalization expenses and various expenses were analyzed by structural variation degree method.Interrupted time series analysis(ITSA)was used to analyze the trend of hospitalization costs of patients undergoing interventional therapy for cerebrovascular diseases from 2020 to 2024,and univariate analysis and generalized linear regression model were used to analyze the influencing factors of hospitalization costs of patients undergoing interventional therapy for cerebrovascular diseases after the actual operation of DRG.Results:The overall structural variation degree of each hospitalization cost was 12.05%,and the items with the largest structural contribution rate were health materials cost(43.09%)and medicine cost(29.77%),and the cumulative contribution rate was 72.86%.ITSA results showed that the overall hospitalization cost of patients with cerebrovascular disease undergoing interventional therapy decreased significantly,and the average monthly decrease was 154.82 yuan during the actual operation of DRG.The results of generalized linear regression showed that the treatment site,overall planning area,hospitalization days and admission status were the factors affecting the hospitalization cost of patients with cerebrovascular disease undergoing interventional therapy.Conclusion:The DRG payment reform can effectively control the average hospitalization cost of patients,but the cost structure still needs to be further optimized.Hospitals should consider the impact of treatment site,overall planning area and admission status on the cost,and reasonably control the number of days in hospital,so as to further reduce the cost of cerebrovascular disease interventional treatment and the economic burden of patients.
出处
《中国医疗保险》
2025年第5期78-87,共10页
China Health Insurance
基金
山西省大健康产业高质量发展科研专项课题“构建山西省卒中急诊救治体系”(DJKZ XKT2023009)。
关键词
DRG
脑血管介入治疗
结构变动法
中断时间序列
住院费用
DRG
cerebrovascular interventional therapy
structural variation method
interrupted time series
hospitalization expenses
