摘要
目的分析不同支付方式的女性乳腺癌患者住院费用,为合理控制乳腺癌住院费用提供依据。方法收集厦门市某三甲医院2004-2012年入院接受治疗且信息完整的女性乳腺癌患者的人口学、疾病、治疗和住院费用资料,采用Gamma模型分析医保与非医保患者的各项住院费用的差异,并估计边际均值及其95%可信区间。结果共纳入451例乳腺癌住院患者,其中医保患者占71.2%;医保与非医保患者中位住院费用分别为12696.4元和11216.5元,其中药品费分别占40.0%和38.8%,检查费分别占23.2%和22.5%,床位费分别占4.5%和4.3%。在控制协变量的影响后,医保和非医保患者的总住院费用(8889.5元vs 6807.6元)、药品费(1721.2元vs 1290.9元)、检查费(3366.5元vs 2400.6元)和床位费(488.9元vs 299.6元)差异均有统计学意义,医保患者的总住院费用、药品费、检查费和床位费分别是非医保患者的1.31、1.33、1.40和1.63倍。结论基于Gamma模型分析支付方式对乳腺癌住院费用的影响具有一定的科学合理性。医疗支付方式在一定程度上影响女性乳腺癌患者的住院费用,医保患者住院费用高于非医保患者,药品费、检查费和床位费是主要的差异来源。
Objective To study the difference of hospitalization expenses between insured and uninsured female breast cancer patients with Gamma model. Methods The female patients with breast cancer in a tertiary hospital in Xiamen from Jan 1,2004 to Dec 31,2012 were recruited into our study, whose demographics, disease situation, treatment and hospitalization expenses were collected. Gamma model was applied to analyze hospitalization expenses for insured and uninsured patients under control of other covariates, and to estimate marginal means. Results The study included 451 patients with 71.2% of which were insured. For insured and uninsured patients,the median cost of hospitalization was 12696.4 RMB and 11216. 5 RMB, re- spectively. The proportions of the compositions of hospitalization cost were 40. 0% and 38.8% for drug cost, 23.2% and 22. 5 % for examination cost, 4. 5 % and 4. 3 % for bed cost, respectively. After controlling other covariates, total hospitalization cost（8889.5 RMB vs. 8889.5 RMB） ,drug cost（ 1721.2 RMB vs. 1721.2 RMB） ,examination cost（3366.5 RMB vs. 3366.5 RMB ）, and bed cost（488. 9 RMB vs. 488.9 RMB ） between insured and uninsured patients were significantly different. Total cost,drug cost,examination cost and bed cost of insured patients were higher than uninsured patients with 0. 31,0. 33,0. 40 ,and 0.63 times respectively. Conclusion For its advantage in deal with skewed data,the Gamma model has its own rationality and validity on analysis of hospitalization expense. The hospitalization expense of female breast cancer patients with medical insur- ance was higher than uninsured patients. Drug cost, examination cost and bed cost made a main contribution of difference.
出处
《中国卫生统计》
CSCD
北大核心
2016年第5期738-741,共4页
Chinese Journal of Health Statistics
基金
国家自然基金青年项目(71403229)
厦门市科技计划项目(3502Z20143006)
关键词
支付方式
住院费用
Gamma模型
乳腺癌
Medical payments
Hospitalization expenses
Gamma model
Breast cancer
