以5种癌症患者住院费用为例探讨其药占比及医保支付

doi:10.6040/j.issn.1671-7554.0.2018.1401

摘要/Abstract

摘要： 目的探讨2013~2017年间5种主要恶性肿瘤疾病患者的住院费用、药占比及医保支付方式特点及其变化趋势,为统筹推进取消药品加成、调整医疗服务价格等改革提供参考依据。方法以山东省某三甲医院第一诊断为胃癌、肺癌、结直肠癌、食管癌、乳腺癌的住院患者为研究对象,描述其住院费用特点,并采用ANOVA或χ²以及趋势检验进行各因素不同年份比较及趋势分析。结果共纳入癌症住院患者20 138例,结果显示,2017年食管癌患者人均住院费用最高(34 137.96元)。2013~2017年5种癌症患者的药品费用所占比总体呈下降趋势,但住院费用无明显下降,其中肺癌患者住院费用增长显著。此外,3种医保类型统筹补偿比例差距较大。结论 5年间药占比的逐年降低并未带来住院费用的显著降低,癌症患者住院经济负担依然如旧。应在控制住院总费用的基础上继续降低药占比,缩小各类医保类型补偿比例差距,以切实减轻患者的经济负担。

关键词: 癌症, 住院费用, 药占比, 医保统筹支付

Abstract: Objective To analyze the features and variation trends of the hospitalization expenses, drug proportions and payment methods of medical insurances among cancer inpatients between 2013 and 2017, in order to provide references for eliminating drug additions, adjusting medical service prices, and accelerating the establishment of new compensation mechanisms for public hospitals. Methods Patients whose first diagnosis was gastric cancer, lung cancer, colorectal cancer, esophageal cancer, or breast cancer were selected from a tertiary hospital in Shandong Province from 2013 to 2017. The characteristics of hospitalization expenses were described. The trends in different years were analyzed with one-way ANOVA and χ² test. Results A total of 20 138 inpatients were involved. In 2017, patients with esophageal cancer had the highest hospitalization expenses(34 137.96 yuan). From 2013 to 2017, the drug proportions were generally on the decline, but there was no obvious decrease in hospitalization expenses. On the contrary, the hospitalization expenses of lung cancer patients increased significantly. In addition, there was a large gap in the compensation proportions among the three types of medical insurances. Conclusion The annual decrease of drug proportion does not bring significant reduction to hospitalization expenses. The economic burden of cancer inpatients is still heavy. The drug proportion should continue to be reduced based on the controlling of the total hospitalization expenses. The gap in the compensation proportion of various types of medical insurances should be narrowed to effectively alleviate the financial burden of patients.

Key words: Cancer, Hospitalization expenses, Drug proportion, Overall payment of medical insurance

中图分类号:

杨玉霞,臧素洁,冷安丽,王健. 以5种癌症患者住院费用为例探讨其药占比及医保支付[J]. 山东大学学报 (医学版), 2019, 57(4): 113-118.

YANG Yuxia, ZANG Sujie, LENG Anli, WANG Jian. Analysis of the proportion of drug expenses and medical insurance payment based on hospitalization expenses of five cancer patients[J]. Journal of Shandong University (Health Sciences), 2019, 57(4): 113-118.

参考文献

[1] Laudicella M, Walsh B, Burns E, et al. Cost of care for cancer patients in England: evidence from population-based patient-level data[J]. Br J Cancer, 2016, 114(11): 1286-1292.
[2] Mariotto AB, Yabroff KR, Shao YW, et al. Projections of the cost of cancer care in the United States: 2010-2020[J]. J Natl Cancer Inst, 2011, 103(2): 117-128.
[3] Luengo-Fernandez R, Leal J, Gray A, et al. Economic burden of cancer across the European Union: a population-based cost analysis[J]. Lancet Oncol, 2013, 14(12): 1165-1174.
[4] Wei F, Wu YF, Tang L, et al. Trend analysis of cancer incidence and mortality in China[J]. Sci China Life Sci, 2017, 60(11): 1271-1275.
[5] 段纪俊, 严亚琼, 杨念念, 等. 中国恶性肿瘤发病与死亡的国际比较分析[J/CD]. 中国医学前沿杂志(电子版), 2016, 8(7): 17-23. DUAN Jijun, YAN Yaqiong, YANG Niannian, et al. International comparison analysis of Chinas cancer incidence and mortality[J/CD]. Chinese Journal of the Frontiers of Medical Science(Electronic Version), 2016, 8(7): 17-23.
[6] 段纪俊, 陈万青, 张思维, 等. 中国恶性肿瘤死亡率的国际比较[J]. 中国社会医学杂志, 2009, 26(6): 377-378. DUAN Jijun, CHEN Wanqing, ZHANG Siwei, et al. International comparison of maligant tumor mortality[J]. Chinese Journal of Social Medicine, 2009, 26(6): 377-378.
[7] 郑荣寿, 顾秀瑛, 李雪婷, 等. 2000~2014年中国肿瘤登记地区癌症发病趋势及年龄变化分析[J]. 中华预防医学杂志, 2018, 52(6): 593-600. ZHENG Rongshou, GU Xiuying, LI Xueting, et al. Analysis on the trend of cancer incidence and age change in cancer registry areas of China, 2000 to 2014[J]. Chinese Journal of Preventive Medicine, 2018, 52(6): 593-600.
[8] Chen WQ, Zheng RS, Baade PD, et al. Cancer statistics in China, 2015[J]. CA Cancer J Clin, 2016, 66(2): 115-132.
[9] 付振涛, 徐爱强, 赵滢, 等. 2013年山东省恶性肿瘤发病和死亡水平分析[J]. 中华肿瘤防治杂志, 2017, 24(18): 1261-1267. FU Zhentao, XU Aiqiang, ZHAO Ying, et al. Cancer incidence and mortality in Shandong province, 2013[J]. Chinese Journal of Cancer Prevention and Treatment, 2017, 24(18): 1261-1267.
[10] Kim S, Kwon S. Impact of the policy of expanding benefit coverage for cancer patients on catastrophic health expenditure across different income groups in South Korea[J]. Soc Sci Med, 2015, 138: 241-247. doi:10.1016/j.socscimed.2015.06.012.
[11] 马莉, 陈学忠, 刘元强, 等. 兰州市四种常见老年癌症直接经济负担分析[J]. 中国老年学杂志, 2011, 31(17): 3352-3354.
[12] 张义华, 王增珍. 恶性肿瘤患者年住院费用研究[J]. 中国卫生经济, 2006, 25(12): 72-73.
[13] 董惠玲, 鹿子龙, 王媛媛, 等. 2010-2012年山东省6县区主要恶性肿瘤疾病负担研究[J]. 现代预防医学, 2016, 43(7): 1235-1238. DONG Huiling, LU Zilong, WANG Yuanyuan, et al. Burden of malignant tumor in six counties of Shandong, 2010-2012[J]. Modern Preventive Medicine, 2016, 43(7): 1235-1238.
[14] Chien CR, Shih YC. Economic evaluation of bevacizumab in the treatment of non-small cell lung cancer(NSCLC)[J]. Clinicoecon Outcomes Res, 2012, 4: 201-208. doi:10.2147/CEOR.S27770.
[15] Elkin EB, Bach PB. Cancers next frontier: addressing high and increasing costs[J]. JAMA, 2010, 303(11): 1086-1087.
[16] 马金姝, 王莹. 济南市2009-2012年居民人口及疾病负担分析[J]. 中国公共卫生, 2014, 30(2): 222-224. MA Jinshu, WANG Ying. Population burden and burden of disease in Ji'nan city, 2009-2012[J]. Chinese Journal of Public Health, 2014, 30(2): 222-224.
[17] Xu K, Evans DB, Kawabata K, et al. Household catastrophic health expenditure: a multicountry analysis[J]. Lancet, 2003, 362(9378): 111-117.
[18] 王梅, 王媛媛, 郭斌, 等. 我国肺癌疾病的直接住院费用负担现状及其问题[J]. 中国卫生经济, 2007, 26(6): 59-62. WANG Mei, WANG Yuanyuan, GUO Bin, et al. Status quo and issues of direct impatient cost of lung carcinoma in China[J]. Chinese Health Economics, 2007, 26(6): 59-62.
[19] 石春雷, 娄培安, 石菊芳, 等. 中国1996-2014年肺癌经济负担研究系统评价[J]. 中国公共卫生, 2017, 33(12): 1767-1774. SHI Chunlei, LOU Pei'an, SHI Jufang, et al. Economic burden of lung cancer in mainland China, 1996-2014: a systematic review[J]. Chinese Journal of Public Health, 2017, 33(12): 1767-1774.
[20] 王增亮, 张国丽, 冯德坤, 等. 基于病案首页数据的肺恶性肿瘤患者住院费用分析[J]. 中国病案, 2018, 19(3): 74-77. WANG Zengliang, ZHANG Guoli, FENG Dekun, et al. Analysis on the hospitalization expenditure of lung cancer based on front pages of medical records[J]. Chinese Medical Record, 2018, 19(3): 74-77.
[21] 赵少峰, 吕红亮, 彭映姝, 等. 肺癌患者住院费用影响因素分析: 以四川省某三甲医院为例[J]. 预防医学情报杂志, 2014, 30(5): 342-345. ZHAO Shaofeng, LÜ Hongliang, PENG Yingshu, et al. Study on factors influencing hospitalization expenses of lung cancer in a tertiary hospital of Sichuan[J]. Journal of Preventive Medicine Information, 2014, 30(5): 342-345.
[22] 陈治水, 冷家骅, 高广颖, 等. 五类肿瘤疾病住院费用及其影响因素分析[J]. 中国卫生经济, 2014, 33(7): 57-60. CHEN Zhishui, LENG Jiahua, GAO Guangying, et al. Analysis on hospitalization expense of five kinds of cancers and its influencing factors[J]. Chinese Health Economics, 2014, 33(7): 57-60.
[23] 浙江将15种大病“高价药”纳入医保[J]. 中国医疗保险, 2015, 3: 72.
[24] Yip WC, Hsiao WC, Chen W, et al. Early appraisal of China's huge and complex health-care reforms[J]. Lancet, 2012, 379(9818): 833-842.
[25] 王翠娟, 尚明, 佟峰. 山东省肺癌住院患者直接经济负担影响因素分析[J]. 中国医院统计, 2016, 4: 254-257. doi: 10.3969/j.issn.1006-5253.2016.04.005. WANG Cuijuan, SHANG Ming, TONG Feng. Study on the influencing factors of direct economic burden and medical insurance system of lung cancer patients in Shandong Province[J]. Chinese Journal of Hospital Statistics, 2016, 4: 254-257. doi: 10.3969/j.issn.1006-5253.2016.04.005.

相关文章 14

[1]	吴瑞芳,李长忠. 女性生育力保护的现状与进展[J]. 山东大学学报 (医学版), 2022, 60(9): 1-7.
[2]	吴新莹,冯一平,常开锋,贾贤杰,薛付忠. 绿色覆盖与癌症发病的因果关联分析[J]. 山东大学学报 (医学版), 2022, 60(8): 115-119.
[3]	侯茹男,邵頔,秦廷廷,尚美美,申玉珍,孙晓杰. 山东省癌症患者烟草使用情况及影响因素分析[J]. 山东大学学报 (医学版), 2022, 60(6): 102-106.
[4]	郑昊天,王光辉,赵小刚,王亚东,曾榆凯,杜贾军. 基于数据库LKB1突变肺腺癌DNA异常甲基化位点构建的预后风险模型[J]. 山东大学学报 (医学版), 2022, 60(3): 51-58.
[5]	姜小峰,姚静静,朱大伟,何平,石学峰,孟庆跃. 补偿机制改革对山东省某县级公立医院住院服务的影响[J]. 山东大学学报 (医学版), 2020, 1(9): 95-102.
[6]	邵纯纯,张媛,洪凡真,肖娟,刘焕娣,贾红英,张英辉. 山东省某三甲医院瘢痕子宫产妇再次分娩住院费用及其影响因素[J]. 山东大学学报 (医学版), 2019, 57(2): 88-92.
[7]	华星星,孙晓杰,赵德利,刘卫东,倪志松,邹跃威,马仲锋,姚能亮,王家林,王海鹏. 山东省5县癌症患者治疗方式和医疗费用及其相关性分析[J]. 山东大学学报 (医学版), 2018, 56(6): 69-75.
[8]	林萍珍,薛娇美,杨蓓,李萌,周麦琳,曹枫林. 基于Pearson相关系数的癌症患者创伤后成长与心理适应相关性的Meta分析[J]. 山东大学学报（医学版）, 2017, 55(9): 110-121.
[9]	蔡远楚,王家林,张军,姚能亮,孙晓杰. 山东省5县癌症幸存者工作状况及影响因素[J]. 山东大学学报（医学版）, 2017, 55(4): 96-100.
[10]	刘京生, 刘桂华, 杜昆, 赵倩, 翁韶波, 赵学英, 张喜庄, 金讯波. 中国人群中血清TK1对不同恶性肿瘤诊断价值的Meta分析[J]. 山东大学学报（医学版）, 2015, 53(9): 71-79.
[11]	马延霞. 临床护理路径在老年髋关节置换术患者中的应用[J]. 山东大学学报（医学版）, 2014, 52(Z1): 173-173.
[12]	朱文龙. 恶性肿瘤颈椎骨转移患者腰硬膜外腔吗啡给药的镇痛效果[J]. 山东大学学报（医学版）, 2014, 52(S1): 136-137.
[13]	孔繁莉, 席雅琳, 高羽. 临床药师对癌症患者疼痛治疗的药学监护[J]. 山东大学学报（医学版）, 2014, 52(S1): 45-45.
[14]	林阿丽,孙青 . 编码hGM-CSF基因的慢病毒包装及表达[J]. 山东大学学报(医学版), 2007, 45(6): 554-557.

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed