从胆囊切除术病例看我国近年住院费用结构的发展变化.DOCVIP

从胆囊切除术病例看我国近年住院费用结构的发展变化 黄媛①，江芹②，王珊②，张振忠① 国家自然科学基金项目哈尔滨医科大学哈尔滨 150086 国家卫生计生委卫生发展研究中心北京 100191 作者简介：黄媛（1991-），女，硕士在读；研究方向：医疗支付制度研究；电话E-mail:1981447101@。 通讯作者：张振忠，电话：010E-mail: HYPERLINK mailto:zhangzzc@126.com zhangzzc@126.com。 摘要 目的：通过胆囊切除术病例，了解近4年我国住院费用结构的变化情况，为我国进一步推进医疗服务价格和支付方式改革提供参考。方法：通过现场调研，收集我国东、中、西部各2家三级甲等医院2013-2016年胆囊切除术患者的病案首页资料，描述住院费用的动态数列变化情况，采用卡方检验分析次均住院费用构成比的变化情况。结果：2013-2016年，6所医院开腹胆囊切除术和腹腔镜下胆囊切除术病例的住院费用水平和结构的变化趋势保持一致。两者住院费用总体均增长了10%左右，其中检查费增长速度最快，医务性劳务费和医用耗材费用增长速度次之，药品费总体呈下降趋势。近4年，胆囊切除术病例的住院费用结构发生显著变化（P＜0.01），药占比显著降低；耗材占比、医务性劳务占比、检查占比均显著升高。结论：我国医务人员劳务价值逐渐体现，药占比逐渐得到控制，而检查占比和耗材占比却显著升高，住院费用结构有待进一步优化。 关键词 胆囊切除术 住院费用结构 医用耗材费用 支付方式改革 医务人员劳务价值 中图分类号文献标识码 A 文章编号 DOI To Analyze the Changes of Hospitalization Expense and Structure of China in Recent Years Through the Cases of Cholecystectomy. Abstract Objective: Understanding the changes of medical consumables in hospitals in China in the past four years through the cases of cholecystectomy, to provide suggestions for further reform of medical service sprice and payment policy. Methods: Collecting the information on the home page of hip arthroplasty in the middle, east and west of China from 2013 to 2016 through investigation. Using the sequential and base ratio to describing the changes of hospitalization cost. Using chi-square test to analyze the changes of hospitalization cost and its composition ratio. Results: During 2013-2016, the hospitalization expense level and the structural change trend of laparoscopic cholecystectomy and laparoscopic cholecystectomy in 6 hospitals were consistent. The overall hospitalization cost increased by about 10%. Among them, the rate of the increase of examination cost was the fastest, then are the growth rate of medical labor and medical consumables, and the overall drug cost decreased. In the last four years, there were significant differences in the changes of hospitalization expenses structural in the cases of cholecystectomy (P