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  • 中文摘要:

    目的:探索在医保支付改革的大背景下,研究某三甲医院脑梗死患者住院费用的影响因素,以期对脑梗死病组实行更精细化管理。方法:选择2020年-2023年“脑缺血性疾患”病组的病例,利用描述性统计分析、卡方检验以及二元logistic 回归模型进行影响因素分析。结果:纳入研究病例3 981份,2020年-2023年患者次均费用10 779.19元,其中药品费、检查费、治疗费是住院费用的主要组成部分,占比分别为18.53%、25.20%、35.57%;该病组每年医保都为超支状态,每年例均超支分别为644.85元、369.43元、1 545.51元、1 767.84元;患者的性别、入院途径、有无并发症、是否危重、住院天数和出院科室是影响住院费用的主要因素。结论:为适应医保支付方式改革,各医疗机构应加强病种成本核算,合理控制医疗费用,降低住院天数以减少医保超支,助推医院精细化管理;医保部门应根据当地实际情况,动态调整病组权重及分组方案,实现医、保、患三方共赢。

  • 英文摘要:

    Objective:In order to explore the influencing factors of hospitalization costs of cerebral infarction patients in a certain grade A tertiary hospital under the background of medical insurance payment reform,in order to implement more refined management of cerebral infarction patients. Methods:The cases of cerebral ischemic disorders(cerebral infarction)from 2020 to 2023 were selected,and the influencing factors were analyzed by descriptive statistical analysis,Chi-square test and binary logistic regression model. Results:3,981 cases were included in the study,and the average cost of patients from 2020 to 2023 was 10,779.19 yuan,among which drug cost,examination cost and treatment cost were the main components of hospitalization cost,accounting for 18.53%,25.20% and 35.57%,respectively. The medical insurance in this group overspent every year,and the overspent cases were 644.85 yuan,369.43 yuan,1,545.51 yuan and 1,767.84 yuan,respectively. The main factors affecting the hospitalization cost are the gender of the patient,the way of admission,whether there are complications,whether the hospital is critical,the number of days in hospital and the department discharged. Conclusion:In order to adapt to the reform of medical insurance payment method,all medical institutions should strengthen the cost accounting of diseases,control medical expenses reasonably,reduce the number of hospitalization days to reduce the overspending of medical insurance,and promote the fine management of hospitals. At the same time,the medical insurance department should dynamically adjust the weight of the patient group and the grouping plan according to the local actual situation,so as to achieve a win-win situation among medical,insurance and patients.