武汉市肺结核患者直接医疗费用及其影响因素

张帆; 申丽君; 刘昭; 刘跃华

doi:10.16462/j.cnki.zhjbkz.2019.10.023

武汉市肺结核患者直接医疗费用及其影响因素

doi: 10.16462/j.cnki.zhjbkz.2019.10.023

张帆¹,
申丽君²,
刘昭¹,
刘跃华^1, ,

1.
100191 北京, 国家卫生健康委卫生发展研究中心, 卫生技术评估科室
2.
518055 深圳, 清华大学医院管理研究院

基金项目:

国家自然科学基金 71804032

教育部人文社会科学研究规划基金/青年基金/自筹经费项目 16YJCZH064

中国疾病预防控制中心结核病防治合作项目（三期） 2019-102

详细信息

通讯作者:
刘跃华, E-mail: liu_yuehua@163.com

中图分类号: R521;R19
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- 被引次数: 0
出版历程
- 收稿日期: 2019-05-06
- 修回日期: 2019-08-01
- 刊出日期: 2019-10-10

Direct medical expenses and its influencing factors of patients with pulmonary tuberculosis in Wuhan

1.
Health Technology Assessment Section, China National Health Development Research Center, Beijing 100191, China
2.
Institution for Hospital Management of Tsinghua University, Shenzhen 518055, China

Funds:

National Natural Science Foundation of China 71804032

The Ministry of Education Project of Humanities and Social Science 16YJCZH064

The Tuberculosis Control Project of Chinese Center for Disease Control and Prevention 2019-102

More Information

Corresponding author: LIU Yue-hua, E-mail: liu_yuehua@163.com

摘要

摘要: 目的通过对2011-2018年武汉市1.7万例肺结核患者直接医疗费用及其影响因素分析，研究肺结核患者疾病医疗负担，为结核病患者相关保障政策优化提供依据。方法对125万条医保结算信息使用秩和检验，对住院、门诊直接医疗费用分组分析；使用多元线性回归和广义线性估计模型，对患者单次住院及年费用进行多因素分析。结果次均门诊、次均住院、年人均直接医疗费用依次为147.51元、8 849.57元、9 607.01元，次均门诊报销比6.36%，住院报销比为67.56%。患者性别、年龄、医保类型、医院级别、是否进行手术、是否使用中药及就医发生年份为直接医疗费用的主要影响因素（均有P < 0.01）。结论现有肺结核患者住院医疗费用在可负担范围内，贫困结核患者疾病负担较重，结核治疗周期长，门诊保障不足，亟待出台有针对性的门诊报销统筹政策。
- 肺结核 /
- 直接医疗费用 /
- 影响因素
Abstract: Objective To analyze the direct medical expenses and its influencing factors of patients with pulmonary tuberculosis (TB) from 2011 to 2018 in Wuhan, so as to provide references for improving the TB derating policy. Methods A total of 1 258 953 medical records were studied, the direct medical expenses and its influencing factors were analyzed by rank sum test, multivariable linear regression and generalized estimated equation. Results The average direct medical expense of TB outpatients was 147.51 yuan each time, while that of TB inpatients was 8 849.57 yuan; and the average direct medical expenses of each year was 9 607.01 yuan per person. The average reimbursement ratio for TB outpatients was 6.36%, and 67.56% for inpatients. Analysis on the influencing factors showed that the direct medical expenses were related with patients' age, sex, year, health care insurance, medical institution and whether they had surgery and Chinese traditional medicine or not (all P < 0.01). Conclusions The current direct medical expenses of TB inpatients are relatively affordable, but low-income patients and patients still have heavy financial burden. TB treatment cycle is long and the outpatient medical service B also safficient. Improved derating policy is in need.
- Pulmonary tuberculosis /
- Direct medical expenses /
- Influencing factors

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表 1 患者年直接医疗费用构成及特征分布

Table 1. Composition and characteristic distribution of patients' annual direct medical expenses

年份^a	N^b	费用及构成				平均就诊次数		平均报销比例
年份^a	N^b	总费用(x±s)(元)	费用增长率(%)^c	药物类占(%)	诊断类占比(%)	住院(次)	门诊(次)	住院(%)	门诊(%)
2012	9 795	4 221.27±10 308.31	-	54.86	21.11	0.47	14.45	70.18	3.56
2013	10 691	6 363.37±14 090.59	50.75	51.80	24.54	0.67	15.15	70.62	4.46
2014	11 520	8 042.04±15 863.85	26.38	51.17	28.73	0.84	15.18	70.26	5.13
2015	12 278	10 889.17±19 803.44	35.40	47.50	31.28	1.06	14.40	68.99	6.48
2016	12 590	12 263.21±23 778.41	12.62	45.12	31.83	1.05	14.12	65.84	7.23
2017	12 503	12 721.40±24 512.10	3.74	38.66	31.09	0.97	14.50	65.99	7.85
2018	13 557	13 607.26±21 335.65	6.97	37.78	34.96	0.96	14.59	63.92	9.70
合计	82 934	9 607.01±19 751.7	-	44.65	30.63	0.86	14.63	67.56	6.36
注：^a由于2011年数据不足一整年，统计年均费用时剔除，2018年数据收集至11月初，2018全年费用及就诊次数估算为：收集数据/0.8；^b样本量为当年就诊患者人数；^c费用增长率与上一年比值。

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表 2 患者直接医疗费用单因素分析

Table 2. Single-factor analysis of patients' direct medical expenses

变量	住院患者			门诊患者			合计
变量	次均费用(元)	Z值	P值	次均费用(元)	Z值	P值	年均费用(元)	Z值	P值
性别		22.70	< 0.001		19.01	< 0.001		5.66	< 0.001
女	7 850.76±10 605.71			145.06±317.49			8 691.54±16 489.03
男	9 368.67±14 255.00			148.64±363.38			10 071.52±21 201.18
年龄(岁)		49.96	< 0.001		3411.87	< 0.001		3 204.07	< 0.001
≤30	956.55±9 136.23			130.33±325.60			7 123.74±13 701.46
30~	8 922.37±13 762.59			151.65±391.67			9 100.62±20 065.96
60~	9 224.35±13 924.56			146.61±266.99			12 819.57±22 577.02
参保方式		15.71	< 0.001		84.41	< 0.001		57.33	< 0.001
城职保	8 765.29±13 382.86			146.26±350.33			9 066.76±19 594.95
城居保	9 296.66±11 768.42			214.13±300.35			15 509.85±20 482.77
医院级别		12 231.94	< 0.001		261 000.00	< 0.001
一级	2 164.64±2 094.88			80.02±146.00
二级	5 188.38±4 989.02			242.11±479.60
三级	9 750.78±13 883.42			314.72±578.48
发生住院								235.28	< 0.001
否							1 769.05±5 034.92
是							20 285.89±26 256.34
发生手术		90.07	< 0.001					119.01	< 0.001
否	7 216.60±9 081.46			6 985.24±14 550.29
是	18 822.94±24 658.25			33 815.67±37 258.78
中药		28.85	< 0.001		5.04	< 0.001		44.57	< 0.001
未使用	7 730.80±11 642.17			146.71±353.10			5 358.48±15 938.82
使用	9 695.09±14 110.97			148.78±344.06			10 116.21±20 100.26
所有记录	8 849.57±13 141.37			147.51±349.59			9 607.01±19 751.70

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表 3 肺结核患者直接医疗费用多因素分析

Table 3. Multivariate analysis of direct medical expenses for tuberculosis patients

变量	住院患者单次费用				患者年费用
变量	β	s_x^-	t值	P值	β	s_x^-	t值	P值
常量	6.00	0.01	509.08	< 0.001	6.40	0.05	133.34	< 0.001
性别
女	ref
男	0.05	0.00	12.85	< 0.001	0.04	0.03	1.46	0.150
年龄(岁)
≤30	ref
30~	0.11	0.01	21.17	< 0.001	0.36	0.04	8.55	< 0.001
60~	0.20	0.01	35.50	< 0.001	0.54	0.04	14.37	< 0.001
参保方式
城镇职工医保	ref
城镇居民医保	0.03	0.01	6.50	< 0.001	-0.06	0.02	-2.71	< 0.001
医院级别
二级医院	ref
一级医疗机构	-0.54	0.01	-53.71	< 0.001
三级医院	0.46	0.01	56.90	< 0.001
住院天数(单次/-/年)	0.76	0.00	297.10	< 0.001	0.71	0.01	122.41	< 0.001
是否手术
否	ref
是	0.59	0.01	111.58	< 0.001	0.51	0.01	38.85	< 0.001
中药
未使用	ref
使用	0.07	0.00	17.54	< 0.001	0.29	0.04	6.75	< 0.001
年份^a	0.08	0.00	76.16	< 0.001	0.11	0.00	26.30	< 0.001
注：^a表示患者单次记录分析年份范围为2011-2018年；年费用分析年份范围为2012-2018年。

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参考文献(14)

[1]	李玉杰. 健康教育在控制结核病发生发展中的作用[J]. 中国实用医药, 2007, 2(32): 147-148. DOI: 10.3969/j.issn.1673-7555.2007.32.117. Li YJ. The role of health education in controlling the occurrence and development of tuberculosis[J]. China Practical Medicine, 2007, 2(32): 147-148. DOI: 10.3969/j.issn.1673-7555.2007.32.117.
[2]	World Health Organization. Global tuberculosis report 2018[EB/OL]. (2018-9-18)[2019-2-10]. https://www.who.int/tb/publications/global_report/en/.
[3]	中华人民共和国国务院办公厅. "十三五"全国结核病防治规划[J]. 中国实用乡村医生杂志, 2017, 24(5): 1-5. https://www.cnki.com.cn/Article/CJFDTOTAL-GWYB201707007.htm General Office of the State Council of the People's Republic of China. National tuberculosis control plan for the 13th five-year plan[J]. Chinese Practical Journal of Rural Doctors, 2017, 24(5): 1-5. https://www.cnki.com.cn/Article/CJFDTOTAL-GWYB201707007.htm
[4]	白丽琼. 湖南省肺结核病经济负担及其影响因素研究[D]. 长沙: 中南大学, 2009. Bai LQ. Study on the economic burden of tuberculosis and its influencing factors in Hunan Province[D]. Changsha: Central South University, 2009.
[5]	Raviglione M, Director GTB. Global strategy and targets for tuberculosis prevention, care and control after 2015[J]. Geneva, World Health Organization, 2013. DOI: 10.1016/S0140-6736(12)60727-2.
[6]	张加胜. 耐多药肺结核患者的医疗费用、经济负担及补偿现状——38例患者个案研究[D]. 济南: 山东大学, 2011. DOI: 10.7666/d.y1937965. Zhang JS. Medical expenses, financial burden and compensation status of MDR-TB patients: 38 case studies[D]. Jinan: Shandong University, 2011. DOI: 10.7666/d.y1937965.y1937965.
[7]	罗惠文, 戴垚垚, 王建明. 肺结核病患者疾病经济负担及其影响因素分析[J]. 中国初级卫生保健, 2012, 26(3): 4-7. DOI: 10.3969/j.issn.1001-568X.2012.03.002. Luo HW, Dai BB, Wang JM. Analysis of the economic burden of tuberculosis and its influencing factors[J]. Chin Primary Health Care, 2012, 26(3): 4-7. DOI: 10.3969/j.issn.1001-568X.2012.03.002.
[8]	何铁牛, 徐旭卿, 李群. 浙江省卫生部结核病控制项目县与非项目县家庭疾病经济负担的比较分析[J]. 中国防痨杂志, 2002, 24(5): 275-278. DOI: 10.3969/j.issn.1000-6621.2002.05.011.He TN, Xu XQ, Li Q. A comparative analysis of the economic burden of family diseases between tuberculosis control project counties and non-project counties of the ministry of health of Zhejiang Province[J]. Chin J Antituberc, 2002, 24(5): 275-278. DOI: 10.3969/j.issn.1000-6621.2002.05.011.
[9]	吴来娃, 严非, 王伟, 等. 上海市肺结核患者直接医疗费用及经济负担分析[J]. 中国防痨杂志, 2012, 34(10): 664-669. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFLZ201210012.htm Wu LW, Yan F, Wang W, et al. Analysis of direct medical expenses and economic burden of tuberculosis patients in Shanghai[J]. Chin J Antituberc, 2012, 34(10): 664-669. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFLZ201210012.htm
[10]	刘昭, 申丽君, 张帆, 等. 不同价格场景下二线抗结核药品疗程费用及总费用测算[J/OL]. 中国药物经济学, 2019(8): 13-18, 51[2019-09-11]. http://kns.cnki.net/kcms/detail/11.5482.R.20190823.1617.004.html. Liu Z, Shen LJ, Zhang F, et al. Estimation of course cost and total cost of second-line antituberculosis drugs under different price scenarios[J/OL]. China Journal of Pharmaceutical Economics, 2019(8): 13-18, 51. http://kns.cnki.net/kcms/detail/11.5482.R.20190823.1617.004.html.
[11]	白丽琼, 肖水源, 李艳红, 等. 发现延误对肺结核经济负担的影响[J]. 中国防痨杂志, 2012, 34(11): 697-3703. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFLZ201211004.htm Bai LQ, Xiao SY, Li YH, et al. Discovered the impact of delays on the economic burden of tuberculosis[J]. Chin J Antituberc, 2012, 34(11): 697-703. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFLZ201211004.htm
[12]	徐旭卿. 耐药肺结核病的卫生经济学评价[D]. 杭州: 浙江大学, 2006. Xu XQ. Health economics evaluation of drug-resistant tuberculosis[D]. Hangzhou: Zhejiang University, 2006.
[13]	郁娟. 兰州市区医院慢性阻塞性肺疾病患者住院费用及影响因素分析[D]. 兰州: 兰州大学, 2018. Yu J. Analysis of hospitalization expenses and influencing factors of COPD patients in Lanzhou urban hospital[D]. Lanzhou: Lanzhou University, 2018.
[14]	简伟研, 方海. 门诊服务对住院服务替代效应的实证分析[J]. 北京大学学报(医学版), 2015, 47(3): 459-463. DOI: 10.3969/j.issn.1671-167X.2015.03.017. Jian WY, Fang H. An empirical analysis of the substitution effect of outpatient service on inpatient service[J]. Journal of Peking University (Health Sciences), 2015, 47(3): 459-463. DOI: 10.3969/j.issn.1671-167X.2015.03.017.