摘要
目的近年来,居民的医疗保健支出不断增加,肝癌患者经济负担沉重。本研究分析肝癌患者医疗费用的变化规律和影响因素,为合理控制肝癌患者的医疗费用提供依据。方法选取广州市某三甲医院2001-01-01-2016-12-31肝癌住院患者8 623例,分析其住院费用的变化趋势及构成情况,根据四分位数将平均住院费用分为4个等级作为因变量,采用Logistic回归分析其主要影响因素。结果 2001-2016年,肝癌住院患者平均住院天数从22.680d减少至14.410d,经居民消费价格指数(consumer price index,CPI)调整后平均住院费用从50 036.566元下降至43 375.471元。药品费占住院费用的比重最大,为44.39%,其次是诊疗费(28.00%)、检查费(10.42%)。多因素Logistic回归分析结果显示,住院年份(χ~2=410.490,P<0.001)、患者来源(χ~2=41.096,P<0.001)、住院天数(χ~2=3 889.488,P<0.001)、是否手术(χ~2=711.744,P<0.001)、疗效(χ~2=213.398,P<0.001)是肝癌患者住院费用的影响因素。以住院费用四分位为因变量,采用多分类的Logistic回归分析结果显示,与2013-2016年相比,在住院费用≤25%中,住院年份OR2001-2004=393.741(95%CI:165.719～935.510),OR2005-2008=75.458(95%CI:34.162～166.674),OR2009-2012=9.103(95%CI:4.334～19.118);在住院费用26%～50%中,住院年份OR2001-2004=70.747(95%CI:33.086～151.277),OR2005-2008=19.380(95%CI:9.544～39.353),OR2009-2012=3.529(95%CI:1.815～6.861);在住院费用51%～75%中,住院年份OR2001-2004=11.343(95%CI:5.932～21.689),OR2005-2008=4.949(95%CI:2.695～9.088),OR2009-2012=1.695(95%CI:0.953～3.016)。结论自2001年以来,肝癌患者住院费用不断上升,CPI调整后住院费用总体呈下降趋势,影响住院费用的主要因素已经初步得到控制,患者的经济负担相对减轻。
OBJECTIVE Medical expenditure has been increased and the liver cancer has resulted in a heavy economic burden.This study aimed to analyze the changes in hospitalization costs and influencing factors of in-patients with liver cancer,and provide theoretical evidences for the control of medical expenditure.METHODS After data pre-processing,8 623 lung cancer in-patients with liver cancer who was hospitalized in a certain 3 Ahospital in Guangzhou from January 1 st,2001 to December 31 th,2016 were included.A description of the hospitalization costs was made and logistic regression was used to analyze the influencing factors of hospitalization costs.RESULTS From 2001 to 2016,the mean hospital stay was decreased from 22.680 days to 14.410 days,Adjusted by consumer price index(CPI),the hospitalization expenditure was decreased from 50 036.566 RMB to 43 375.471 RMB.The medicine expense(44.39%)accounted for the largest proportion of the hospitalization expenditure,followed by the physician fee(28.00%)and examination fee(10.42%).The year of hospitalization(X^2=410.490,P<0.001),the source of patients(X^2=41.096,P<0.001),the mean hospital stay(X^2=3 889.488,P<0.001),with or without surgery(X^2=711.744,P<0.001)and curative effect(X^2=213.389,P<0.001)were significantly associated with the hospitalization costs.Comparing the hospital expenditure below 25% in 2013-2016,the results were OR2001-2004=393.741(95%CI:165.719-935.510),OR2005-2008=75.458(95%CI:34.162-166.674),OR2009-2012=9.103(95%CI:4.334-19.118).As for the hospital expenditure between 26%and 50%,comparing the period in 2013-2016,the results were OR2001-2004=70.747(95%CI:33.086-151.277),OR2005-2008=19.380(95%CI:9.544-39.353),OR2009-2012=3.529(95%CI:1.815-6.861).For the hospital expenditure between 51% and 75%in 2013-2016,the results were OR2001-2004=11.343(95%CI:5.932-21.689),OR2005-2008=4.949(95%CI:2.695-9.088),OR2009-2012=1.695(95%CI:0.953-3.016).CONCLUSIONS The hospitalization expenditure of in-patients with liver cancer from 2001 to 2016 in Guangzhou was increased,while adjusted by CPI,the hospitalization costs were decreased generally.These illustrate that the main influencing factors of the expenditure has been preliminarily controlled,and the financial burden of in-patients has been relatively reduced since 2001.
作者
谢丽莎
吴凌云
张磊
邓鑫磊
郭健炜
颜志恒
温立强
XIE Li-sha;WU Ling-yun;ZHANG Lei;DENG Xin-lei;GUOJian-wei;YAN Zhi-heng;WEN Li-qiang(Sun Yat-sen Memorial Hospital,Sun Yat-sen University,Guangzhou 510120,P.R.China;School of Public Health,Sun Yat-sen University,Guangzhou 510080,P.R.China)
出处
《中华肿瘤防治杂志》
CAS
北大核心
2019年第5期336-340,344,共6页
Chinese Journal of Cancer Prevention and Treatment
关键词
肝癌
住院费用
影响因素
LOGISTIC回归
liver cancer
hospitalization costs
influencing factors
logistic regression
