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目的:对不同医保类型冠心病PCI手术患者的住院费用进行比较,为相关部门降低医疗费用提供建议。方法:以广州市某三甲医院2010—2014年行PCI手术患者住院费用为研究对象,运用回顾性分析、描述性分析、秩和检验等方法,分析新型农村合作医疗、广州医保、公费医疗三种不同医保类型患者的费用构成及影响因素。结果:公费医疗患者的住院费用和住院天数均显著高于新型农村合作医疗及广州医保患者;三组患者住院费用中,材料费所占比例均最高(65%以上),其次为治疗处置费、药品费等;除药品费各组间无统计学差异(P=0.537)外,其余费用结构均存在显著差异(P<0.01);置入支架个数与种类是影响总费用的主要因素。结论:卫生行政部门应从住院天数、高值耗材使用、药品价格等方面重点监管,控制住院总费用;改善医保付费方式,引导参保方合理利用卫生资源,逐步推进公费医疗改革。
OBJECTIVE: To compare the hospitalization costs of patients undergoing PCI with different types of medical insurance in order to reduce the medical expenses of relevant departments. Methods: The hospitalization costs of patients undergoing PCI during 2010-2014 in Guangzhou First Hospital were studied. Retrospective analysis, descriptive analysis, rank sum test and other methods were used to analyze three kinds of new rural cooperative medical care, medical insurance in Guangzhou and public medical expenses Cost Composition and Influencing Factors of Different Medicare Type Patients. Results: The cost of hospitalization and hospital stay in public medical patients were significantly higher than those in new rural cooperative medical care and Guangzhou medical insurance patients. Among the three groups of hospitalized patients, the proportion of materials cost was the highest (65%), followed by treatment and disposal costs, Drug costs, etc. There were significant differences in other cost structures except for drug costs among all groups (P = 0.537) (P <0.01). The number and types of stent placement were the main factors affecting the total cost. Conclusion: The health administrative department should supervise and control the total cost of hospitalization from the days of hospitalization, the use of high-value consumables and the price of medicines, improve the medical insurance payment mode, guide the insured to make rational use of health resources and gradually push forward the public-funded medical reform.