摘要目的 以急性阑尾炎为例,分析2014年至2016年住院患者医疗费用及其影响因素,为公立医院改革和控费机制优化提出政策建议.方法 选取广东省珠海市和贵州省遵义市共4家医院,采取分层随机抽样方法抽取1 114例急性阑尾炎病案首页进行医疗费用分析.利用Excel2013、SPSS 22. 0软件,采用灰色关联分析方法分析住院费用的影响因素.结果 手术患者控费效果优于非手术患者;耗材费用整体上涨明显; 2014 年至2016 年非手术患者的药品费用占比分别为39.5% 、41.2%和41.7% .治疗费用、诊断费用、药品费用、综合医疗服务费对住院总费用有较大影响; 医疗机构级别、患者年龄、是否手术等因素对住院费用有显著影响.结论 急性阑尾炎患者住院费用受多种因素影响.建议进一步加强耗材控制、加强医院精细化管理和针对性控费、完善价格补偿机制、深化医保支付方式改革,以有效控制医疗费用不合理增长.

abstractsObjective To analyze the medical expenses of inpatients and its influencing factors in 2014-2016 with acute appendicitis taken as an example, and to put forward policy suggestions for the public hospital reform and the cost control optimization. Methods A total of 4 hospitals were chosen from Zhuhai of Guangdong and Zunyi of Guizhou. 1 114 cases of acute appendicitis were selected to analyze the medical expenses. The influencing factors of hospitalization expenses were analyzed by grey correlation analysis. Results The effect of the cost control of surgical patients was better than non-surgical patients. The total cost of consumables increased obviously. The proportion of non-surgical patients′ drug expenses were 39. 5% , 41. 2% and 41. 7% in 2014 -2016 respectively. The total hospitalization expenses were greatly affected by the treatment expense, diagnostic expense, drug expense, comprehensive medical service expense. The level of medical institutions, age and operation had significant impacts on medical expenses. Conclusions The hospitalization expenses of inpatients with acute appendicitis are influenced by many factors. In order to effectively control the irrational growth of medical expenses, the government is recommended to further strengthen the control of consumables, strengthen the fine management of hospitals and targeted cost control, improve the mechanism of price compensation and deepen the medical insurance payment methods reform.