王丽莎,闫晓婷,李娜,等.西北地区综合医院康复科近6年住院患者费用及相关因素分析[J].中华物理医学与康复杂志,2025,47(7):631-637
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| 西北地区综合医院康复科近6年住院患者费用及相关因素分析 |
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| DOI：10.3760/cma.j.cn421666-20240913-00740 |
| 中文关键词: 康复科 住院费用 医保支付 疾病诊断相关分组支付 |
| 英文关键词: Rehabilitation costs Total inpatient cost Health insurance Diagnosis-related payments |
| 基金项目:国家自然科学基金资助项目（32071372）；陕西省重点研发项目—社会发展领域基金（2024SF-YBXM-693） |
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| 中文摘要: |
| 目的 分析近6年西安交通大学第一附属医院康复科住院患者在医保支付方式改革前、后其住院费用变化情况，并进一步探讨影响康复住院总费用的相关因素，为康复科医保支付制度改革提供参考。 方法 收集2018年5月至2024年5月期间该院康复科住院患者（共16827例）的病案首页信息，采用非参数检验分析患者住院费用变化及相关影响因素。 结果 该院康复科患者近6年次均住院总费用为（14574.92±10524.79）元，西药费用占比从2018年的17.1%逐年降低至2024年的7.6%。入选患者中合并高血压的占比（51.94%）最高，合并糖尿病的患者占比（占20.10%）次之，而合并感染患者的康复住院总费用最高；在功能障碍层面，以运动障碍患者的数量占比最高（59.02%），其次为言语障碍患者占比（17.45%），而吞咽障碍患者的住院费用最高。此外，2023年医保支付方式从按服务支付(FFS)转变为按疾病诊断相关分组（DRGs）支付后，康复科常见病种患者日均住院支出均逐渐下降，在2024年日均支出均达到历史最低水平。 结论 医保支付方式由FFS支付转变为DRGs支付后，康复科住院患者总药费占比逐年下降，常见病种患者的日均住院费用亦明显减少，但综合服务费及诊断费用逐年上升，通过探讨影响康复科患者住院总费用的相关因素及原因，为改进康复机构医保支付方式提供了数据参考。 |
| 英文摘要: |
| Objective To analyze the changes in the costs of hospital rehabilitation after the reform of health insurance payments in the past 6 years, and to identify relevant factors which can provide a reference for the reform of the health insurance payment system in rehabilitation department. Methods Information on 16,827 patients hospitalized in the rehabilitation department of The First Affiliated Hospital of Xi′an Jiaotong University between May 2018 and May 2024 was collected and subjected to non-parametric analysis. Results The average hospitalization cost of rehabilitation department patients over the six years was Y14,574.92±10,524.79. During that time the proportion of the cost attributable to Western medicine decreased from 17.1% in 2018 to 7.6% in 2024. The proportion of the patients with hypertension was 51.94%, followed by diabetes mellitus (20.10%). Those with infections had the highest total hospitalization costs. Motor disorders were the most common dysfunction (59.02%), followed by speech disorders (17.45%). Patients with swallowing disorders had the highest hospitalization costs. After the payment system shifted from fee-for-service (FFS) to payment by diagnosis-related group (DRG) in 2023, the average daily inpatient expenditures for rehabilitation patients with all types of diseases gradually declined, reaching its lowest level in 2024. Conclusions After the health insurance payments shifted from FFS to DRG, the proportion of in patients′ total drug costs decreased annually, and the average daily costs of patients with different types of diseases also decreased significantly, but the comprehensive service fee and diagnostic costs increased. |
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