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目的通过对子宫肌瘤手术患者住院费用影响因素的分析,探讨单病种定额付费管理的利弊,为单病种付费管理提供实证参考。方法收集某院2012年-2014年间子宫肌瘤按单病种定额结算的病例1631份,采用描述性分析、单因素方差分析、多元线性回归方法分析住院费用的构成及影响因素。结果单病种子宫肌瘤手术住院治疗费用构成中药品费比例最高(27.81%)、其次是手术麻醉费(26.60%)、材料费次之(25.41%)。多因素结果分析结果显示术式分组、手术麻醉费占比、材料费占比、药费占比、住院天数、手术范围、诊断数量与住院费用均显著相关。结论单病种限价付费是控制住院费用的有效手段。应制定合理的单病种限价标准并适时调整,推行DRGs预付模式,改革医疗服务价格体系,加强医院管理,切实解决“看病贵”的问题。
Objective To analyze the influencing factors of hospitalization expenses in patients with uterine fibroid surgery and to explore the pros and cons of fixed-payment management in single-disease cases and to provide an empirical reference for pay-for-disease management. Methods A total of 1631 cases of uterine leiomyoma diagnosed by single disease were collected from 2012 to 2014 in a hospital. Descriptive analysis, one-way ANOVA and multivariate linear regression were used to analyze the composition and influencing factors of hospitalization expense. Results The cost of inpatient treatment of single-disease uterine fibroids accounted for the highest proportion of Chinese medicines (27.81%), followed by surgical anesthesia (26.60%) and materials (25.41%). Multivariate analysis of the results showed that surgical grouping, accounting for the proportion of surgical anesthesia, material costs, accounting for the proportion of drugs, hospitalization days, the scope of the operation, the number of diagnoses and hospitalization costs were significantly correlated. Conclusion Single disease limit payment is an effective means to control the cost of hospitalization. We should formulate a reasonable single disease limit price standard and adjust it in due time. We should promote DRGs prepaid mode, reform the medical service price system, strengthen hospital management and effectively solve the problem of “expensive medical treatment”.