摘要
目的探究死亡患者住院费用的影响因素。方法提取2020—2023年死亡住院患者的病案首页信息,运用描述性、分位数回归模型分析住院费用。结果死亡患者年龄越小、住院时间越长、罹患疾病数量越多则负担越重,但90%分位数时病种越多负担反降。门诊较急诊患者在50%水平以下对费用呈负向影响。医保支付随着费用增高,对住院总费用影响由正转负,对住院自付费用影响为正且持续增强。结论①在死亡患者群体中,年龄的增长与临终医疗费用的降低显著相关;②住院时间、罹患疾病数量的增加促进医疗费用增长;③入院途径与病情严重程度是决定医疗费用的基础性因素,计划性的门诊入院治疗在控制成本方面具有优势,病情的复杂性是高额费用核心的内在动因;④医疗保险支付方式的保障功能背后可能涉及供给诱导需求与过度医疗。
Objective To identify the factors influencing hospitalization expenses among deceased patients.Methods We extracted medical record data of patients who died during hospitalization between 2020 and 2023.Descriptive statistics and quantile regression models were employed to analyze hospitalization costs.Results Younger age,longer hospital stays,and a greater number of diagnosed diseases were generally associated with higher hospitalization expenses.However,at the 90th percentile,a higher disease burden was correlated with reduced financial burden.Compared to emergency admissions,outpatient admissions demonstrated a negative association with costs below the 50th percentile.Medical insurance coverage showed a shifting impact:its effect on total hospitalization expenses transitioned from positive to negative as costs increased,while its influence on out-of-pocket expenses remained positive and strengthened progressively.Conclusion Our findings indicate that:①Older age is significantly associated with lower end-of-life medical expenses;②Longer hospitalization and greater disease complexity contribute to increased medical costs;③Admission route and disease severity are fundamental determinants of expenses,with planned outpatient admissions showing cost containment advantages,while clinical complexity remains the primary driver of high costs;④The protective function of medical insurance payment mechanisms may involve elements of supplier-induced demand and potential overutilization of medical services.
作者
张锦卉
陆皓杰
莫艺萱
ZHANG Jinhui;LU Haojie;MO Yixuan(The First Affiliated Hospital of Soochow University,Suzhou 215008,China;School of Public Health,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China)
出处
《现代医院》
2025年第11期1748-1752,1756,共6页
Modern Hospitals
关键词
死亡患者
住院费用
影响因素
Deceased patients
Hospitalization expenses
Influence factors
