CAJ | 학술논문

目的：比较按项目付费（ fee-for-service，FFS）和单病种付费两种不同医疗保险付费方式对急性单纯性阑尾炎患者住院费用的影响。方法于2013年2月，采用分层抽样法在长沙市抽取20家医院。在该20家医院中选取符合本研究纳入及排除标准的急性单纯性阑尾炎患者208例。根据医疗保险付费方式，将其分为按项目付费组133例和单病种付费组75例。收集并比较两组患者的临床资料和各项住院费用，包括患者年龄、性别、入住医院等级、医疗结局、平均住院天数、检查费用、麻醉费用、手术费用及药物费用等。结果两组患者性别比较，差异无统计学意义（P﹥0.05）；两组患者平均年龄、平均住院天数及入住医院等级比较，差异有统计学意义（P﹤0.05）；以术后并发症评价医疗结局，两组患者均无术后并发症发生。两组患者医疗费用、检查费用、手术费用、麻醉费用、药物费用及抗菌药物费用比较，差异有统计学意义（ P﹤0.05）。多元线性回归分析显示，医疗保险付费方式、性别、年龄及住院天数对急性单纯性阑尾炎患者抗菌药物费用的影响有统计学意义（ P﹤0.05）。结论在不改变医疗结局的基础上，单病种付费组患者的医疗费用、检查费用、手术费用、麻醉费用、药物费用及抗菌药物费用均低于按项目付费组患者。单病种付费方式对急性单纯性阑尾炎患者住院过程中的各项费用有一定控制作用。
목적：비교안항목부비（ fee-for-service，FFS）화단병충부비량충불동의료보험부비방식대급성단순성란미염환자주원비용적영향。방법우2013년2월，채용분층추양법재장사시추취20가의원。재해20가의원중선취부합본연구납입급배제표준적급성단순성란미염환자208례。근거의료보험부비방식，장기분위안항목부비조133례화단병충부비조75례。수집병비교량조환자적림상자료화각항주원비용，포괄환자년령、성별、입주의원등급、의료결국、평균주원천수、검사비용、마취비용、수술비용급약물비용등。결과량조환자성별비교，차이무통계학의의（P﹥0.05）；량조환자평균년령、평균주원천수급입주의원등급비교，차이유통계학의의（P﹤0.05）；이술후병발증평개의료결국，량조환자균무술후병발증발생。량조환자의료비용、검사비용、수술비용、마취비용、약물비용급항균약물비용비교，차이유통계학의의（ P﹤0.05）。다원선성회귀분석현시，의료보험부비방식、성별、년령급주원천수대급성단순성란미염환자항균약물비용적영향유통계학의의（ P﹤0.05）。결론재불개변의료결국적기출상，단병충부비조환자적의료비용、검사비용、수술비용、마취비용、약물비용급항균약물비용균저우안항목부비조환자。단병충부비방식대급성단순성란미염환자주원과정중적각항비용유일정공제작용。
Objective To compare the influences on the hospital cost for patients with acute simple appendicitis between two medical insurance payment methods:fee-for-service( FFS)and single disease paying. Methods In February 2013,20 hospitals in Changsha were included by stratified sampling method,and 208 patients with acute simple appendicitis were selected from these 20 hospitals according to the inclusion and exclusion standards of the study. According to the payment methods of medical insurance,the subjects were divided into two groups:FFS group(n=133)and single disease paying group ( n=75). The clinical data and the hospital cost of various items were collected and compared,including age,gender,hospital level,treatment outcome, average length of hospital stay, examination cost, anesthesia cost, surgery cost and medication cost. Results The two groups were not signigicantly different(P﹥0. 05)in gender;the two groups were significantly different ( P ﹤0. 05 ) in average age, average length of hospital stay and hospital level;the treatment outcomes were measured by postoperative complications which were not found in the two groups. The two groups were significantly different(P ﹤0. 05)in hospital cost,examination cost,surgery cost,anesthesia cost,medication cost and the cost of antibacterial drugs. Multivariate linear regression analyses showed the payment methods of medical insurance,gender,age,length of hospital stay had significant influence(P﹤0. 05)on the cost of antibacterial drugs for patients with acute simple appendicitis. Conclusion With the same treatment outcome,single disease paying group was lower than FFS group in medical cost,examination cost,anesthesia cost, surgery cost,medication cost and antibacterial drug cost. To some extent,the single disease paying method may control the costs of inpatients with acute simple appendicitis.