發(fā)布時間：2018-05-30 03:38

  本文選題：腦出血 + 醫(yī)療保險��； 參考：《天津醫(yī)科大學(xué)》2013年碩士論文

【摘要】：目的：通過對天津市2003～2007年參加城鎮(zhèn)職工基本醫(yī)療保險的腦出血患者住院費用資料的描述,了解天津市參保腦出血患者的一般人口學(xué)特征、了解其住院費用分布及明細(xì)構(gòu)成；通過對資料的分析,找出影響住院費用的主要因素；通過對數(shù)據(jù)的深入挖掘,發(fā)現(xiàn)導(dǎo)致住院費用超限的潛在原因。為合理控制腦出血患者住院費用,降低患者家庭經(jīng)濟負(fù)擔(dān)提供參考依據(jù)。 方法：在天津市2003～2007年參加城鎮(zhèn)職工基本醫(yī)療保險的患者資料庫中抽取腦出血患者記錄總數(shù)的15%,共計3119例,剔除住院天數(shù)與住院次數(shù)為“0”或缺失的觀測,剩余有效例數(shù)2895例。運用SPSS13.0對患者個人情況及各住院費用明細(xì)進(jìn)行一般統(tǒng)計描述。對參�；颊叩淖≡嘿M用及其影響因素進(jìn)行多元線性回歸分析,采用數(shù)據(jù)挖掘關(guān)聯(lián)規(guī)則分析中的Apriori算法對導(dǎo)致患者住院費用超限的因素進(jìn)行探索,運用R(2.14.2)軟件對患者住院費用情況進(jìn)行多元線性回歸分析以及關(guān)聯(lián)規(guī)則分析。 結(jié)果：(1)天津市2003～2007年參加城鎮(zhèn)職工基本醫(yī)療保險的腦出血患者住院人均總費用中位數(shù)為10913.17元。住院費用中藥品費、治療費、檢查費所占比例最大,分別占47.7%、25.3%、10.3%,三者共計83.3%,占患者住院費用的主要部分。5個年度的費用呈逐年上升趨勢,2005年略有回落。參保患者中男性患者占68.5%,女性患者占31.5%；參保患者年齡平均(63.46±11.98)歲,其中青年組占4.9%、中年組占34.7%、老年組占60.4%；參保患者住院1次的占82.2%,2次及以上的占17.8%;參�；颊咦≡禾鞌�(shù)中位數(shù)19天,平均(22.77±18.01)天；參�；颊咦鍪中g(shù)的占29.3%,未做手術(shù)的占70.7%；參保患者在一級醫(yī)院住院的占0.9%,在二級醫(yī)院住院的占21.3%,在三級醫(yī)院住院的占77.8%；參�；颊叩膮⒈�區(qū)縣中,在市內(nèi)六區(qū)的占73.7%,在濱海新區(qū)的占5.1%,在環(huán)城四區(qū)的占14.7%,在兩區(qū)三縣的占6.5%。(2)單因素分析結(jié)果顯示：不同性別、不同年齡組、不同住院次數(shù)分組之間患者住院費用差異無統(tǒng)計學(xué)意義(P0.05)；進(jìn)行手術(shù)治療患者的住院費用高于非手術(shù)患者(P0.05)；三級醫(yī)院患者住院費用高于一級醫(yī)院和二級醫(yī)院(P0.05)；市內(nèi)六區(qū)和環(huán)城四區(qū)的參保患者住院費用較濱海新區(qū)和兩區(qū)三縣的患者高(P0.05)。(3)多元線性回歸分析結(jié)果顯示：性別和參保區(qū)縣因素對住院費用影響無統(tǒng)計學(xué)意義(P0.05)；患者住院費用隨患者年齡增大而增長；患者住院費用隨患者住院次數(shù)增加而減少；患者住院費用隨患者住院醫(yī)院的級別增高而增長。各個影響因素中：對住院費用的增長影響最大的因素為患者的住院天數(shù)；其次為患者進(jìn)行手術(shù)；然后為患者住院的醫(yī)院類別,三級醫(yī)院對住院費用的影響較一、二級醫(yī)院大。(4)關(guān)聯(lián)規(guī)則分析結(jié)果顯示：手術(shù)因素與住院天數(shù)因素是導(dǎo)致腦出血患者住院費用超限最主要的因素,性別、醫(yī)院類別、住院次數(shù)等因素也是患者住院費用超限的相關(guān)因素。 結(jié)論：通過對天津市參保腦出血患者住院費用的一般描述、多元線性回歸分析以及關(guān)聯(lián)規(guī)則分析,得到了影響住院費用的主要因素。 對于患者來說,控制住院費用的途徑主要包括：(1)在病情不加重的前提下,無需做手術(shù)治療的患者盡量采取保守治療,必須做手術(shù)的患者應(yīng)盡早采取手術(shù)治療；(2)合理控制患者住院天數(shù),減少不必要的住院時間,控制住院期間產(chǎn)生的檢查、材料、床位等費用；(3)可以在二級醫(yī)院就診的患者盡量減少去三級醫(yī)院住院治療次數(shù)；(4)對于已發(fā)病的患者應(yīng)及早控制住病情,對患病風(fēng)險高的患者應(yīng)積極采取預(yù)防措施,將腦出血的發(fā)病控制在最低限度。 對于衛(wèi)生決策部門來說,合理規(guī)劃配置衛(wèi)生資源、建立健全醫(yī)療保險政策制度是提高人民生活質(zhì)量、構(gòu)建和諧社會的重要保證。
[Abstract]:Objective: to understand the general demographic characteristics of the patients with cerebral hemorrhage in Tianjin, and to find out the distribution and composition of the hospitalization expenses, through the analysis of the data, and to find out the main factors affecting the hospitalization expenses through the description of the data of the hospitalization expenses of the patients with cerebral hemorrhage in Tianjin for 2003~2007 years. Through the thorough excavation of the data, the potential causes of excessive hospitalization costs are found, which provide a reference for the rational control of the hospitalization expenses of the patients with cerebral hemorrhage and the reduction of the family economic burden of the patients.
Methods: a total of 15% of the total number of cerebral hemorrhage patients were extracted from the database of patients who participated in the basic medical insurance of urban workers in Tianjin for 2003~2007 years. A total of 3119 cases were taken out of the number of hospitalization days and hospitalization times "0" or missing. The number of remaining effective cases was 2895 cases. The patients' personal situation and the cost of hospitalization were carried out by SPSS13.0. General statistical description. Multivariate linear regression analysis was carried out on the hospitalization expenses of the insured patients and their influencing factors. The Apriori algorithm in data mining association rules was used to explore the factors that resulted in patients' hospitalization expenses, and the R (2.14.2) software was used to carry out multiple linear regression analysis and correlation of patients' hospitalization expenses. Rule analysis.
Results: (1) the median per capita total cost of cerebral hemorrhage patients who participated in basic medical insurance for urban workers in Tianjin for 2003~2007 years was 10913.17 yuan per capita. The proportion of hospitalized cost of Chinese medicine, treatment and inspection was the largest, accounting for 47.7%, 25.3%, 10.3%, three of 83.3%, accounting for the main part of the patient's hospitalization expenses for.5 years. There was a year of rising trend year by year, a slight decline in 2005. Male patients accounted for 68.5% of the insured patients, women accounted for 31.5%, the average age of the insured patients (63.46 + 11.98) years, including 4.9% in the youth group, 34.7% in the middle age group, 60.4% in the elderly group, 82.2% in the 1 hospitalized patients and 17.8% in 2 and above, and 68.5% in the median of hospitalized patients. Day, the average (22.77 + 18.01) days, 29.3% of the insured patients, 70.7% without operation, 0.9% in the first level hospital, 21.3% in the two hospital, 77.8% in the three level hospital, 73.7% in the six District of the insured patients, 5.1% in Binhai New Area, and four in the Binhai New Area, four around the city. The area accounted for 14.7%, and the single factor analysis of 6.5%. (2) in three counties in two districts showed that there was no significant difference in the cost of hospitalization between the different sex, the different age groups and the different times of hospitalization (P0.05); the hospitalization expenses of the patients undergoing surgical treatment were higher than those of the non operative patients (P0.05); the hospitalization expenses of the three level hospitals were higher than the first level. The hospital and two level hospital (P0.05); the hospitalization expenses of the insured patients in the six and the four districts of the city were higher than those in the Binhai New Area and the three counties in the two district (3). (3) multivariate linear regression analysis showed that there was no statistical significance (P0.05) for the influence of the gender and the insured area and county factors on the hospitalization expenses (P0.05); the hospitalization expenses of the patients increased with the age of the patients. The hospitalization costs of patients were decreased with the number of hospitalized patients; the hospitalization costs of patients increased with the level of hospitalized hospitals. The effect of hospital on hospitalization costs is more than one, two level hospitals are large. (4) the results of association rules analysis show that the factors of operation factors and hospital days are the most important factors leading to the overlimit of hospitalization expenses in the patients with cerebral hemorrhage, and the factors such as sex, hospital category, and hospitalization are also related factors.
Conclusion: through the general description of the hospitalization expenses of the patients with cerebral hemorrhage in Tianjin, the multiple linear regression analysis and the analysis of the association rules, the main factors that affect the hospitalization cost are obtained.
For the patients, the main ways to control the hospitalization cost include: (1) in the condition that the condition is not aggravated, the patients who do not need to do the operation treatment should take the conservative treatment as far as possible. The patients who must do the operation should take the surgical treatment as soon as possible; (2) the reasonable control of the patient's hospital days, the reduction of the unnecessary hospitalization time, and the control of the inspection during the hospitalization. Check, material, bed and other expenses; (3) the patients who can be hospitalized in the two level hospital should try to reduce the number of hospitalization to the three level hospitals as far as possible; (4) for the patients who have been ill, the patients with high risk should take precautionary measures to control the incidence of cerebral hemorrhage to the minimum.
For the health decision-making department, the rational planning and allocation of health resources and the establishment and improvement of the medical insurance policy system are the important guarantee for improving the people's quality of life and building a harmonious society.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R197.3;R743.34;F842.684

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 鄭大喜;加強醫(yī)院醫(yī)療服務(wù)價格管理的現(xiàn)實思考[J];現(xiàn)代醫(yī)院管理;2004年04期

2 張玉琴;劉詩翔;;腦出血的流行病學(xué)研究進(jìn)展[J];神經(jīng)損傷與功能重建;2007年03期

3 金虹;;按病種付費:市場與政府能否“接軌”[J];醫(yī)院管理論壇;2006年11期

4 關(guān)文標(biāo),羅祖明;卒中病房在腦卒中治療中的作用[J];華西醫(yī)學(xué);2000年03期

5 王燕;徐宏斌;;關(guān)聯(lián)規(guī)則在公安情報分析中的應(yīng)用研究[J];計算機時代;2011年12期

6 張臣乃;實施醫(yī)藥分開核算、分別管理制度的幾點思考[J];江蘇衛(wèi)生事業(yè)管理;2001年04期

7 羅仁國,余定庸,唐文國;高血壓性腦出血術(shù)后嚴(yán)重并發(fā)癥的防治[J];實用臨床醫(yī)學(xué);2002年05期

8 耿昱;江云;;腦出血的診斷與治療[J];全科醫(yī)學(xué)臨床與教育;2009年01期

9 呼鐵民;孫t畔，

本文編號：1953763