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目的应用结构方程模型(SEM)分析天津市医保肝硬化患者住院费用的影响因素,为探索有效的单病种医疗费用控制方式提供参考。方法从天津市2003-2007年医保住院患者资料库中抽取2313例肝硬化患者的病历资料,结合专业知识建立初始通径图,采用LISREL8.7拟合SEM。结果患者年龄、性别对住院费用有直接影响,效应分别为-0.04和0.12,通过住院天数产生间接影响,效应分别为-0.10和-0.08;患者临床特征和医院级别对住院费用直接效应分别为0.55和0.17;住院天数对费用的效应为0.62。结论 SEM是分析住院费用影响因素的一种有效方法。合理控制住院天数、加强三级医院的监管可遏制住院费用的上涨。
Objective To analyze the influencing factors of hospitalization expenses in Medicare-cirrhotic patients in Tianjin using structural equation model (SEM), and to provide a reference for exploring an effective single-disease medical expense control method. Methods A total of 2313 cases of liver cirrhosis patients were collected from 2003-2007 inpatient database of Tianjin Medicare Hospital. The initial path maps were established based on the professional knowledge. LISREL 8.7 was used to fit the SEM. Results The age and gender of the patients had a direct effect on hospitalization costs, with effects of -0.04 and 0.12, respectively. The indirect effects of days of hospitalization were -0.10 and -0.08, respectively. The direct effects of clinical characteristics and hospital grade on hospitalization expenses were 0.55 And 0.17; the effect of hospital stay on cost was 0.62. Conclusion SEM is an effective way to analyze the influencing factors of hospitalization costs. Reasonable control of hospital days, to strengthen the supervision of tertiary hospitals to curb rising costs of hospitalization.