摘要
目的分析甘肃省2014—2018年糖尿病患者住院费用构成、变化趋势及影响因素,为有效控制糖尿病医疗费用提供参考。方法采用多阶段分层整群抽样方法,选取甘肃省不同等级医疗卫生机构2014—2018年80109例糖尿病住院患者作为研究对象,并从医疗信息系统中获取研究对象的人口学特征、报销方式、疾病诊断和住院费用等病例信息。采用SPSS 25.0和R 3.6.0软件进行Spearman秩相关分析、非参数秩和检验、多重线性回归分析和随机森林回归树模型分析糖尿病患者住院费用及影响因素。结果甘肃省2014—2018年糖尿病住院患者次均住院费用由7437.80元下降为5131.34元,平均增长速度为-8.86%;与2014年相比,2018年药品费和检查化验费占比分别由34.98%、43.48%下降至26.91%、33.15%,诊查治疗费和护理费占比分别由10.68%、1.43%上升至25.11%、3.20%。Spearman秩相关分析结果显示,糖尿病患者次均住院费用与年份呈负相关(r_(s)=-1.00,P<0.05)。多重线性回归分析结果显示,性别(β=0.02)、年龄(以<45岁为参照,45~岁β=0.05,65~岁β=0.08)、住院天数(β=0.23)、报销方式(以城镇职工医保为参照,城乡居民医保β=-0.06,自费β=-0.04)、医疗机构级别(以省级为参照,市级β=-0.39,区县及以下β=-0.73)、并发症数目(以无并发症为参照,1个并发症β=0.05,2个及以上并发症β=0.07)、是否手术(β=0.12)、是否使用中药(β=0.04)和药占比(β=0.08)是糖尿病患者次均住院费用的影响因素(P<0.01)。随机森林回归树模型分析结果显示,重要程度排名前5位的影响因素依次为医疗机构级别、住院天数、是否手术、药占比和报销方式。结论甘肃省糖尿病患者住院费用呈下降趋势,但费用构成有待进一步优化,应持续推进分级诊疗就医秩序,落实糖尿病分级诊疗举措,合理缩短住院时间,推进居民基本医疗保险全覆盖,加强医疗保障力度,降低患者经济负担。
Objective To analyze the composition and the trend of hospitalization expenditure and its influencing factors of patients with type 2 diabetes mellitus(T2DM)in Gansu Province from 2014 to 2018,and to provide the references for effective controlling the medical expenses of T2DM.Methods The multi-stage stratified cluster sampling method was used to select 80109 T2DM inpatients from different levels of medical and health organizations in Gansu Province from 2014 to 2018 as the subjects,the demographic characteristics,reimbursement methods,disease diagnosis,hospitalization expenses of the objects were obtained from medical information system.The Spearman rank correlation analysis,nonparametric rank sum test,multiple linear regression analysis and random forest regression tree model analysis were utilized to analyze the hospitalization expenditure and its influencing factors of T2DM patients.The used software was SPSS 25.0 and R 3.6.0.Results From 2014 to 2018,the average hospitalization expenditure of T2DM patients in Gansu Province decreased from 7437.80 yuan to 5131.34 yuan,the average growth rate was-8.86%;as compared with those in 2014,the proportions of medication expenses and examination-laboratory expenses in 2018 decreased from 34.98%and 43.48%to 26.91%and 33.15%,while the proportions of diagnosis-treatment expenses and nursing expenses in 2018 increased from 10.68%and 1.43%to 25.11%and 3.20%.The Spearman rank correlation analysis showed that there was a negative correlation between the average hospitalization expenditure and years in T2DM patients(r_(s)=-1.00,P<0.05).The multiple linear regression analysis results showed that gender(β=0.02),age(as compared with<45 years old,45-years old:β=0.05,65-years old:β=0.08),hospitalization days(β=0.23),reimbursement method(as compared with urban worker medical insurance,medical insurance for urban and rural residents:β=-0.06,self-paying patients:β=-0.04),levels of medical institution(as compared with provincial medical institutions,municipal medical institutions:β=-0.39,medical institutions of district-level and county-level or below:β=-0.73),the number of complications(as compared with no complications,one complication:β=0.05,≥two complications:β=0.07),operation or not(β=0.12),using traditional Chinese medicine or not(β=0.04),the proportion of drugs(β=0.08)were the influencing factors of the average hospitalization expenditure of T2DM patients(P<0.05).The results of random forest regression tree model showed that the top five influencing factors in the ranking of importance were the levels of medical institution,the hospitalization days,operation or not,the proportion of drugs and reimbursement methods.Conclusion The hospitalization expenditure of T2DM patients in Gansu Province declines,but the composition of hospitalization expenditure should be further optimized.It’s necessary to continuously promote the medical treatment order of hierarchical medical treatment,implement the diabetes hierarchical medical treatment measures,shorten the hospitalization days,promote full coverage of basic medical insurance for residents,strengthen medical security and reduce the financial burden of patients.
作者
权佩钦
胡晓斌
王聪
车鑫垚
李巧娥
QUAN Pei-qin;HU Xiao-bin;WANG Cong;CHE Xin-yao;LI Qiao-e(School of Public Health,Lanzhou University,Lanzhou y Gansu Province 730000,China)
出处
《中国慢性病预防与控制》
CAS
CSCD
北大核心
2022年第1期8-13,共6页
Chinese Journal of Prevention and Control of Chronic Diseases
基金
兰州大学服务甘肃省经济社会发展专项研究项目(2019-FWZX-11)
甘肃省卫生健康委员会项目(2019GS-WSZFY-001)
甘肃省糖尿病患者管理现状及医疗费用趋势研究(20191210-(19)0565)。
关键词
糖尿病
住院费用
趋势
影响因素
多重线性回归
随机森林
Diabetes mellitus
Hospitalization expenditure
Trends
Influencing factors
Multiple linear regression
Random forest
