我国城镇脑卒中患者住院卫生服务利用情况及住院费用的影响因素研究

doi:10.12114/j.issn.1007-9572.2020.00.091

摘要/Abstract

摘要： 背景　作为全球第二大常见致死病因，脑卒中给患者带来了极大的经济负担和家庭负担。患者的卫生服务利用状况会影响其医疗费用的支出，但目前关于我国城镇脑卒中患者住院卫生服务利用情况的研究较少。目的　了解我国城镇脑卒中患者的住院服务利用情况，并探讨住院费用的影响因素，为降低患者疾病经济负担、加强患者经济保护、控制医疗费用过快增长提供理论支持和现实依据。方法　数据来源于“全国基本医疗保险卫生服务利用调查数据库”（2010—2015年），于2018年10月采用机械抽样法在数据库中抽取城镇缺血性脑卒中患者56 485例，收集其基本情况和住院服务利用情况（住院次数、住院天数、住院费用）。采用单因素分析比较不同基本情况脑卒中患者的住院服务利用差异，采用多元线性回归分析脑卒中患者住院费用的影响因素。结果　我国城镇脑卒中患者的年均住院次数为1（0）次，次均住院天数为11.0（6.0）d，次均住院费用为6 070.06（8 289.87）元。不同性别、年龄、险种类型、卒中类型、医院级别、地区、城市类别的患者，年均住院次数、次均住院天数、次均住院费用比较，差异有统计学意义（P<0.05）。多元线性回归分析结果显示：性别、年龄、险种类型、卒中类型、医院级别、地区、城市类别、次均住院天数是患者住院费用的影响因素，其中男性患者住院费用较女性高1.8%，年龄每增长1岁患者住院费用上升0.07%，职工医疗保险患者住院费用较居民医疗保险患者高20.1%，卒中类型为入脑前动脉未特指的闭塞或狭窄引起的脑梗死（I63.2）、大脑动脉血栓形成引起的脑梗死（I63.3）患者住院费用分别较脑梗死（I63）患者高40.8%、38.8%，二级、三级医院就诊患者住院费用分别较基层医院就诊患者高72.1%、121.1%，东部地区患者住院费用分别较中部、西部地区高23.5%、34.0%（P<0.05）；住院次数也是患者住院费用的影响因素，住院次数每增加1次患者住院费用上升57.7%（P<0.05）。结论　不同特征脑卒中患者的住院卫生服务利用状况存在差异，住院费用与多种因素有关；应通过提高医院诊疗技术、缩短住院天数、加强对患者的健康教育等方式来实现费用控制，降低患者负担。

关键词: 卒中；卫生服务利用；费用, 医疗；影响因素分析

Abstract: Background　As the second most common cause of death in the world，stroke has brought both great economic burden and family burden to patients.Meanwhile，the utilization of health services will affect patients' medical expenses.However，there are few studies on the utilization of inpatient health services for urban stroke patients in China.Objective　To investigate the utilization of health services among urban stroke inpatients in China and explore the influencing factors of hospitalization costs，in order to provide theoretical support and evidence for reducing the economic burden of diseases，strengthening the economic protection of patients and controlling the excessive growth ofmedical expenses.Methods　We extracted 56 485 cases of ischemic stroke inpatients from "National Basic Medical Insurance and Health Service Utilization Survey Database"（data from 2010 to 2015） by the method of mechanical samplingin October 2018.Inpatients' basic information and their utilization of health service（frequency of hospitalizations，length of stay，and costs of hospitalization） were collected.Univariate analysis was used to comparethe differences in the utilization of inpatienthealth services.Meanwhile，multiple linear regression was adopted to analyze the influencing factors of hospitalization costs.Results　The average annual number of hospitalizations of urban stroke patients in China was 1（0），and the average length of stay was 11.0（6.0） days，and the average hospitalization cost was 6 070.06（8 289.87）yuan.There were differences in the average annual number of hospitalizations，the average length of stay，and the average hospitalization cost among stroke inpatients with different genders，age，insurance types，stroke types，hospital levels，regions，and city levels（P<0.05）.Multiple linear regression analysis showed that genders，age，insurance types，stroke types，hospital levels，regions，city levels，and average length of stay were the influencing factors for the hospitalization cost.Among them，the hospitalization cost of male patients was 1.8% higher than that of female patients；the cost of hospitalization increased by 0.07% for every 1-year-old；the hospitalization cost of stroke inpatients covered by the urban employees' basic medical insurance（UEBMI） was 20.1% higher than those covered by the urban residents' basic medical insurance（URBMI）；the hospitalization cost of patients with cerebral infarction due to unspecified occlusion or stenosis of precerebral arteries（I63.2） and cerebral infarction due to thrombosis of cerebral arteries（I63.3） was 40.8% and 38.8% higher than those of patients with cerebral infarction（I63）；the hospitalization cost of patients who visited secondary as well as tertiary hospitals was 72.1% and 121.1%，respectively，higher than those of patients who visited primary hospitals；and the hospitalization cost of patients in eastern region was 23.5% and 34.0% higher than those of patients in central and western regions，respectively（P<0.05）.The frequency of hospitalizations also was the influencing factor for the hospitalization cost，the cost of hospitalization increased by 57.7% for each additional hospitalization（P<0.05）.Conclusion　There are differences in the utilization of health services for stroke inpatientswith different characteristics，and the hospitalization cost is related to multiple factors.It is essential to take measures such as improving medical technology，shortening the length of stay and strengthening the health educationfor patients to control the hospitalization cost and reduce the economic burden of stroke inpatients.

Key words: Stroke；Health service utilization；Fees, medical；Root cause analysis

杨勇,李硕,王溪,等. 我国城镇脑卒中患者住院卫生服务利用情况及住院费用的影响因素研究[J]. 中国全科医学, 2020, 23(13): 1615-1620. DOI: 10.12114/j.issn.1007-9572.2020.00.091.
YANG Yong,LI Shuo,WANG Xi, et al. The Utilization of Inpatient Health Services and Influencing Factors of Hospitalization Costs of Urban Stroke Patients in China　[J]. Chinese General Practice, 2020, 23(13): 1615-1620. DOI: 10.12114/j.issn.1007-9572.2020.00.091.

参考文献

［1］MUKHERJEE D，PATIL C G．Epidemiology and the global burden of stroke［J］．World Neurosurg，2011，76（suppl 6）：s85-90．DOI：10.1016/j.wneu.2011.07.023.
［2］FEIGIN V L，KRISHNAMURTHI R V，PARMAR P，et al．Update on the global burden of ischemic and hemorrhagic stroke in 1990—2013：the GBD 2013 study［J］．Neuroepidemiology，2015，45（3）：161-176．DOI：10.1159/000441085.
［3］杨帆，曾雪梅，刘治君，等．成都市脑卒中患者康复治疗的医保现状研究［J］．卫生经济研究，2014，31（6）：52-55．DOI：10.14055/j.cnki.33-1056/f.2014.06.018．http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=wsjjyj201406016.
［4］ZHANG H，YIN Y J，ZHANG C，et al．Costs of hospitalization for stroke from two urban health insurance claims data in Guangzhou City，southern China［J］．BMC Health Serv Res，2019，19（1）：1-12．DOI：10.1186/s12913-019-4530-2.
［5］MCMANUS M，OVBIAGELE B，MARKOVIC D，et al．Association of insurance status with stroke-related mortality and long-term survival after stroke［J］．J Stroke Cerebrovasc Dis，2015，24（8）：1924-1930．DOI：10.1016/j.jstrokecerebrovasdis.2015.05.007.
［6］ANDERSEN R M．Revisiting the behavioral model and access to medical care：does it matter?［J］．J Heal Soc Behav，1995，36（1）：1．DOI：10.2307/2137284.
［7］ZHANG H，SUN Y M，ZHANG D L，et al．Direct medical costs for patients with schizophrenia：a 4-year cohort study from health insurance claims data in Guangzhou City，southern China［J］．Int J Ment Health Syst，2018，12：72．DOI：10.1186/s13033-018-0251-x.
［8］LI X，AU-DOUNG L，CHAN E．The impact of ischemic stroke on atrial fibrillation-related healthcare cost：a systematic review［J］．Value Heal，2016，19（7）：A871．DOI：10.1016/j.jval.2016.08.359.
［9］MODREGO P J，PINA M A，LERíN F J．The impact of ageing on stroke subtypes，length of stay and mortality：study in the Province of Teruel，Spain［J］．Acta Neurol Scand，2003，108（6）：435-442．DOI：10.1034/j.1600-0404.2003.00168.x.
［10］WANG J H，BAI L L，SHI M，et al．Trends in age of first-ever stroke following increased incidence and life expectancy in a low-income Chinese population［J］．Stroke，2016，47（4）：929-935．DOI：10.1161/STROKEAHA.115.012466.
［11］PAN Y，CHEN S Q，CHEN M L，et al．Disparity in reimbursement for tuberculosis care among different health insurance schemes：evidence from three counties in central China［J］．Infect Dis Poverty，2016，5：7．DOI：10.1186/s40249-016-0102-4.
［12］CHEN R，LI N X，LIU X．Study on the equity of medical services utilization for elderly enrolled in different basic social medical insurance systems in an underdeveloped city of southwest China［J］．Int J Equity Health，2018，17（1）：54．DOI：10.1186/s12939-018-0765-5.
［13］TUNG Y C，CHANG G M．The effect of cuts in reimbursement on stroke outcome：a nationwide population-based study during the period 1998 to 2007［J］．Stroke，2010，41（3）：504-509．DOI：10.1161/STROKEAHA.109.568956.
［14］国务院．国务院关于整合城乡居民基本医疗保险制度的意见［EB/OL］．（2016-01-12）［2019-08-01］．http://www.gov.cn/xinwen/2016-01/14/content_5032827.htm.
［15］MENG Q Y，FANG H，LIU X Y，et al．Consolidating the social health insurance schemes in China：towards an equitable and efficient health system［J］．Lancet，2015，386（10002）：1484-1492．DOI：10.1016/S0140-6736（15）00342-6.
［16］XU J F，WANG J，KING M，et al．Rural-urban disparities in the utilization of mental health inpatient services in China：the role of health insurance［J］．Int J Health Econ Manag，2018，18（4）：377-393．DOI：10.1007/s10754-018-9238-z.
［17］魏亚卿，李育民，王晓茹，等．糖尿病患者住院费用及影响因素的通径分析［J］．中国卫生经济，2018，37（4）：67-70．DOI：10.7664/CHE20180419.