基于结构变动度的三甲综合医院2014～2016年住院费用结构评价

冯俊　李英利　徐婷婷

[摘要] 目的 了解大型综合医院住院费用结构变动趋势及特征，为控制住院费用不合理增长提供依据。 方法 收集广西某三甲综合医院2014～2016年的住院患者费用资料，运用结构变动值、结构变动度和结构贡献率等指标进行分析。 结果 2014～2016年，三甲医院住院总费用逐年上升，但增速下降，增幅较小。药品费和卫生材料费占住院总费用比例名列前2位。2014～2016年药品费、检查费、诊察费、床位费、治疗费和护理费的结构变动值呈负向变动；化验费、卫生材料费、手术费和其他费用的结构变动值则呈正向变动。药品费和卫生材料费对住院费用变动贡献较大，2项累积贡献率达47.06%。 结论 药费控制政策措施初见成效，但药占比仍较高，还需加强对药品费的管控。住院费用结构不合理，卫生材料费、化验费等比重较高，而体现医护人员技术劳务价值的手术费、护理费等占比较低，费用结构有待调整与优化。

[关键词] 住院费用；结构变动度；费用控制；大型医院

[中图分类号] R197.32 [文献标识码] A [文章编号] 1673-7210（2018）05（a）-0147-04

[Abstract] Objective To analysis the trend and characteristics of hospitalization expenses structure change in a grade Ⅲ level A general hospital， and provide evidence for the unreasonable increase of hospitalization expenses. Methors The hospitalization expenses of patients in a grade Ⅲ level A general hospital from 2014 to 2016 were collected by analyzing the structure changes value， degree of structure variation and structure contribution rate. Results The total hospitalization expenses of the top three hospitals increased year by year from 2014 to 2016， but the growth rate decreased. The proportion of medical expenses and medical materials expenses accounted for the total hospitalization expenses of top 2. The value of negative changes in structure of 2014-2016 medicine fees， examination fees， examination fees， bed charges， treatment fees and nursing； value positive changes in the structure of health laboratory fees， material fee， operation fee and other expenses. The cost of medicine and medical materials contribute greatly to the change of hospitalization expenses. The cumulative contribution rate of these 2 items was 47.06%. Conclusion Expenses control policies for medicine has achieved initial success， but the proportion of medicine expenses is still high which still need to strengthen the medicine expenses control. The structure of hospitalization expenses is unreasonable. The proportion of medical materials and laboratory fees are high. However， the cost of operation and nursing care which reflects the technical labor value of medical staff is relatively low. Expenses structure needs to be adjusted and optimized.

[Key words] Hospitalization expenses； Structural variability degree； Expenses control； General hospital

新一輪医药卫生体制改革实施以来，医院次均费用上涨幅度得到一定控制，但总体上看，医疗费用不合理增长问题仍然存在[1]。2015年原国家卫生计生委等4部委印发《关于控制公立医院医疗费用不合理增长的若干意见》（国卫体改发〔2015〕89号），提出将控制公立医院医疗费用不合理增长作为深化医改的重要目标和任务。在大型公立医院医疗费用构成中，住院费用所占比例较大，因此控制住院费用对控制医院医疗费用过快增长具有重要意义[2]。……