摘要
背景近年来,我国医疗卫生机构的总住院人数和卫生费用支出增加明显。糖尿病住院病例属于可避免住院范畴,我国关于糖尿病可避免住院的相关研究较为缺乏。目的分析东部某地区农村居民糖尿病可避免住院的相关情况,为减少可避免住院的发生、降低卫生费用支出提供参考依据。方法从东部某地区2008-2013年参加新型农村合作医疗居民的报销数据中获得136 887例住院病例随机样本。依据糖尿病的国际疾病分类(ICD)-10编码抽取糖尿病住院病例17 015例。依据可避免住院的纳入排除标准,获得13 052例可避免住院糖尿病病例。对可避免住院病例占总住院病例占比、糖尿病可避免住院病例住院费用的趋势进行分析。结果在糖尿病住院病例中,可避免住院的占比高达76.71%(13 052/136 887)。2008-2013年,糖尿病可避免住院量占总抽样病例的占比整体呈现下降的趋势。其中,2008-2009年为11.15%(3 423/30 678),2010-2011年为10.35%(5 423/52 364),2012-2013年为7.80%(4 206/53 845)。2008-2013年,糖尿病可避免住院病例主要发生在二级医院,占比为68.83%(11 776/15 994)。2008-2010年,糖尿病可避免住院的次均费用从6 177.24元/例上升到6 842.87元/例,2012年下降到6 560.78元/例,2013年上升至6 593.70元/例。2008-2013年糖尿病可避免住院费用占比从9.10%(883.71/9 674.68)下降至4.73%(1 393.91/29 478.02)。结论在糖尿病住院病例中,可避免住院的占比较高,造成了医疗资源的浪费和卫生费用支出的增加,应当围绕改善初级卫生保健服务系统入手,引导患者合理就医,加强不同层级医疗机构间的协作。
Background In recent years,the total number of hospitalizations and healthcare expenditures in China’s medical and health institutions have increased significantly.Diabetes hospitalizations belong to the category of avoidable hospitalizations.There is a lack of relevant research on avoidable hospitalization for diabetes in China.Objective To analyze the situation of avoidable hospitalization for diabetes among rural residents in a region of eastern China,to provide evidence for reducing the occurrence of avoidable hospitalizations and health expenditures.Methods A random sample of 136 887 hospitalized cases was obtained from the reimbursement data of residents who participated in the New Rural Cooperative Medical Scheme from 2008 to 2013 in an eastern region of China.According to the ICD-10 code,17 015 inpatients with diabetes mellitus were selected.According to the standard of avoidable hospitalization,13 052 cases of avoidable diabetes were obtained.The proportion of avoidable hospitalization cases to total hospitalization cases and the trend of avoidable hospitalization expenses of diabetes mellitus cases were analyzed.Results The proportion of avoidable hospitalizations was 76.71%(13 052/136 887).From 2008 to 2013,the proportion of avoidable hospitalizations for diabetes in total sample cases showed a downward trend.Specifically,the proportions were 11.15%(3 423/30 678) in 2008-2009,10.35%(5 423/52 364) in 2010-2011 and 7.80%(4 206/53 845) in 2012-2013,respectively.During the period,the avoidable hospitalizations for diabetes were mainly concentrated in secondary hospitals,accounting for 68.83%(11 776/15 994) of the total.In 2008,the average cost of per avoidable hospitalization for diabetes was 6 177.24 yuan,which increased to 6 842.87 yuan in 2010,and decreased to 6 560.78 yuan in2012,but increased to 6 593.70 yuan in 2013.The proportion of avoidable hospitalization expenses for diabetes mellitus decreased from 9.10%(883.71/9 674.68)in 2008 to 4.73%(1 393.91/29 478.02) in 2013.Conclusion In diabetic inpatients,the ratio of avoidable hospitalizations is high,resulting in the waste of medical resources and the increase of health expenditure.We should focus on improving the primary health care delivery system,guide patients to seek medical treatment rationally,and strengthen the collaboration among different levels of medical institutions.
作者
李飞成
简伟研
孙美平
LI Feicheng;JIAN Weiyan;SUN Meiping(School of Public Health,Peking University Health Science Center,Beijing 100191,China)
出处
《中国全科医学》
CAS
北大核心
2019年第22期2735-2738,共4页
Chinese General Practice
基金
美国中华医学基金会研究项目(CMB-OC-16-259)
关键词
糖尿病
初级卫生保健
住院
费用
医疗
农村卫生
Diabetes mellitus
Primary health care
Hospitaliation
Fees,medical
Rural health
