肾病患者医疗花费趋势研究——基于北京市某三甲医院的分析

doi:10.19723/j.issn.1671-167X.2021.01.033

摘要/Abstract

摘要：

目的: 探究肾病患者医疗费用变化趋势及原因,为医疗改革决策提供参考依据。方法: 使用北京市某三甲医院成年肾病患者2012—2017年门诊及住院数据,利用描述性统计的方法分析患者次均花费和人均花费的时间趋势,并探究医疗花费变化的原因。结果: 肾病患者年均花费在2012—2017年间出现较快上涨。门诊和住院的花费上涨由不同原因导致,其中门诊年均花费的上升来源于患者年均就诊次数的增加,而住院年均花费的上升来源于患者次均花费的增加。住院花费上涨贡献最大的类别为药品和耗材,其中药品类费用上涨贡献最大,2017年次均12 524元,占当年平均次均总花费的32.4%;耗材类次均9 215元,占比23.9%。结论: 门诊年均花费的上升主要来源于肾病患者年均就诊次数的增加,药物类和耗材类费用的增长是导致住院医疗总费用上升的主要因素。治疗类费用以及医疗服务费在总花费中所占比例仍然较低,可能需要适当调整。

关键词: 肾病, 医疗花费, 医疗服务利用, 门诊病人, 卫生保健改革

Abstract:

Objective: To investigate trends in hospitalization expenditures in adults with kidney disease, to analyze the time pattern of outpatient and inpatient medical expenditures for patients with kidney diseases, and to support the health care reform by exploring the causes.Methods: Medical expenditure data for kidney disease patients aged ≥18 years from the outpatient and in-patient data of the information center in the Grade?A tertiary hospital in Beijing, China from January 1, 2012, to December 31, 2017, were retrospectively analyzed. It provided descriptive evidence on the time patterns of expenditures per visit and capita, and potential influencing factors of the time changes were further explored.Results: It was found that medical expenditures had increased rapidly from 2012 to 2017. The result showed that the average outpatient expenditure per capita for kidney disease patients was 4 598 yuan in 2012, with an increasing tendency to 11 536 yuan in 2017. There was an obvious increase in the average number of visits (per year) from 3.94 in 2012 to 9.11 in 2017. Meanwhile, the mean inpatient expenditures per capita had an increasing tendency from 323 753 yuan in 2012 to 45 904 yuan in 2017. There was also an increase of mean inpatient expenditures per admission from 27 184 yuan in 2012 to 34 933 yuan in 2017, with a similar number of admissions over the 6 years. The increases in outpatient and inpatient expenditures per capita were driven by different reasons. The increase in outpatient expenditures per capita was driven by the increase of patient visits, while the increase in inpatient expenditures per capita was driven by the increase of the expenditures per admission. Also, drug and medical materials were the two categories that had the largest contribution to the inpatient expenditures. Drug expenses were the highest one, with an average of 12 524 yuan per visit in 2017, accounting for 32.4% of the average total expenditure in that year, while the average cost of consumables was 9 215 yuan, accounting for 23.9%.Conclusion: The increase of outpatient expenditures per capita was related to the increase of patient visits. Meanwhile, the growth of drug and consumable costs contributed to the total increase in the total inpatient healthcare costs. It is necessary to increase the proportion of treatment costs and medical service fees in the total expenditure.

Key words: Kidney disease, Medical expenditure, Medical utilization, Outpatients, Health care reform

中图分类号:

R197.3

毕书红,李紫繁,汪涛,王悦,张晨,计虹,石菊. 肾病患者医疗花费趋势研究——基于北京市某三甲医院的分析[J]. 北京大学学报（医学版）, 2021, 53(1): 215-219.

BI Shu-hong,LI Zi-fan,WANG Tao,WANG Yue,ZHANG Chen,JI Hong,SHI Ju. Trend in medical expenditures for patients with kidney diseases: An analysis from a tertiary hospital in Beijing[J]. Journal of Peking University (Health Sciences), 2021, 53(1): 215-219.

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Items	Outpatient	Inpatient	Proportion of full sample/%
Gender
Male	6 442	530	66.4
Female	3 263	266	33.6
Age/years
18-40	944	89	9.6
41-64	4 175	274	41.4
≥65	4 831	433	49.0
Total visits
All kidney diseases	9 954	796
Kidney disease	842	248	10.1
Kidney failure	9 112	548	89.9
Average expenditures per visit/yuan
All kidney diseases	1 248.14	38 637.39
Kidney disease	1 083.27	22 022.78
Kidney failure	1 263.37	46 156.42
Average length of inpatient stay/d	-	11.4