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目的:应用单病种住院病例资料,了解反映医务人员劳务价值的手术费用水平及变化情况。方法:收集2003—2012年我国不同地区急性阑尾炎手术患者病案首页资料,描述费用动态数列变化情况,并对手术费用结构比及变化进行统计描述和推断。结果:经CPI调整后,2003—2012年6所医院开腹阑尾切除术患者人均住院总费用增长89.4%;人均手术费增长39.9%;手术费构成比从19.5%降至14.5%,住院费用构成有显著性差异(P<0.000 1)。2008—2012年,经腹腔镜阑尾切除术患者人均住院总费用增长37%;手术费则降低44.6%,构成比从28.8%降至11.7%。结论:现有资料显示我国医务人员劳务价格被低估,价格与价值不符,在未来支付制度与定价体系改革中应给予充分考虑和改善。
OBJECTIVE: To apply single-disease inpatient data to understand the level and changes of operating costs reflecting the labor value of medical personnel. Methods: The data of the first page of medical records of patients with acute appendicitis in different regions of China from 2003 to 2012 were collected to describe the changes of the dynamic series of expenses and the statistical description and inference were made on the cost-structure ratio and changes of operating costs. Results: After CPI adjustment, the total cost of hospitalization for perioperative appendectomy increased by 89.4% in 6 hospitals from 2003 to 2012; the per capita operation cost increased by 39.9%; the cost of surgery decreased from 19.5% to 14.5% There was a significant difference (P <0.000 1). From 2008 to 2012, the total cost of per capita hospitalization for patients undergoing laparoscopic appendectomy increased by 37%; the cost of operation was reduced by 44.6% and the proportion dropped from 28.8% to 11.7%. Conclusion: The existing data show that the medical service personnel in our country are underestimated in labor price, the price is inconsistent with the value, and should be fully considered and improved in the future reform of payment system and pricing system.