摘要
目的运用分位数回归模型分析医药价格综合改革对住院费用及其结构的影响,评价改革成效并提出政策建议。方法以冠心病患者为例,采用整群抽样的方法,选取新疆某三甲医院2017年9月-2018年8月的病历数据1905例为实验组,2016年9月-2017年8月的病历数据3592例为对照组,采用非参数检验、分位数回归方法分析住院各项费用变化情况及其影响。结果2组次均费用、自付费用、材料费用、药品费用等各项费用比较,差异均有统计学意义(P<0.05);分位数回归分析显示,时间变量除在自付费用的P75分位点、药品费用P25分位点和其他费用P50分位点上无影响(P>0.05)外,对其他费用P25分位点及诊疗费用和护理费用各分位点均产生正性影响(P<0.05),而对其余各项费用各分位点均有负性影响(P<0.05)。保险类型除对药品、诊疗、检查和其他费用的P25分位点无影响(P>0.05)外,对其余分位点及各项费用各分位点均有正性影响(P<0.05)。住院天数对各项费用各分位点均有正性影响(P<0.05)。结论医药价格综合改革总体降低了患者的负担,提升了医护人员的劳动价值,但改革还须关注高自付费用项目,加强保险机构的同质化管理。
Objective To analyze the influence of comprehensive medicine price reform on amount and structure of hospitalization expenses using quantile regression model for evaluating the effectiveness of the reform and making policy recommendations.Methods Using cluster sampling,we extracted the data on 1905 coronary disease patients hospitalized during September 2017-August 2018 and 3592 hospitalized during September 2016-August 2017 in a grade A tertiary hospital in Xinjiang Uygur Autonomous Region as the experiment and the control group.Non-parametric test and quantile regression were used to analyze changes in hospitalization expenses and effects of medicine price reform.Results There were significant discrepancies in average hospitalization expenses per hospitalization,out-of-pocket expenses,material expenses,drug expenses and other expenses between the two groups(P<0.05 for all).The results of quantile regression analysis demonstrated that the time variable exerted a significant effect on all quantile values of expenses of all items(including positive effect on all quantile values of diagnosis,treatment,and nursing expenses and on 0.25 quantile value for other expenses,but negative effect on all quantile values of expenses of all remaining items,P<0.05 for all)except for 0.75 quantile value for out-of-pocket expenses,0.25 quantile value for drug expenses and 0.50 quantile value for other expenses(P>0.05 for all);the type of medical insurance showed a significant effect on all quantile values of expenses of all items(P<0.05 for all)but no significant effect on the 0.25 quantile values of expenses for drug,diagnosis/treatment,check-up,and other expenses(all P>0.05);duration of hospitalization had a significant positive effect on all quantile values of expenses for all items(P<0.05 for all).Conclusion The comprehensive medicine price reform has generally reduced hospitalization expenses of patients but special attention should be paid in the reform to items with high out-of-pocket expenses and homogenized management of insurance institutions.
作者
林陶玉
贾丽萍
唐昌敏
方鹏骞
LIN Tao-yu;JIA Li-ping;TANG Chang-min(The First Affiliated Hospital,School of Medicine,Shihezi University,Shihezi,Xinjiang Uygur Autonomous Region 832008,China;不详)
出处
《中国公共卫生》
CAS
CSCD
北大核心
2020年第11期1620-1623,共4页
Chinese Journal of Public Health
基金
国家自然科学基金青年项目(71603077)
石河子大学医学院第一附属医院团队项目(TJ2015-002)。
关键词
医药价格综合改革
住院费用
分位数回归
comprehensive medicine price reform
hospitalization expense
quantile regression
