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林陶玉, 贾丽萍, 唐昌敏, 方鹏骞. 医药价格综合改革对住院费用影响分位数回归模型[J]. 中国公共卫生, 2020, 36(11): 1620-1623. DOI: 10.11847/zgggws1122668
引用本文: 林陶玉, 贾丽萍, 唐昌敏, 方鹏骞. 医药价格综合改革对住院费用影响分位数回归模型[J]. 中国公共卫生, 2020, 36(11): 1620-1623. DOI: 10.11847/zgggws1122668
LIN Tao-yu, JIA Li-ping, TANG Chang-min, . Influence of comprehensive medicine price reform on hospitalization expenses: an analysis with quantile regression model[J]. Chinese Journal of Public Health, 2020, 36(11): 1620-1623. DOI: 10.11847/zgggws1122668
Citation: LIN Tao-yu, JIA Li-ping, TANG Chang-min, . Influence of comprehensive medicine price reform on hospitalization expenses: an analysis with quantile regression model[J]. Chinese Journal of Public Health, 2020, 36(11): 1620-1623. DOI: 10.11847/zgggws1122668

医药价格综合改革对住院费用影响分位数回归模型

Influence of comprehensive medicine price reform on hospitalization expenses: an analysis with quantile regression model

  • 摘要:
      目的   运用分位数回归模型分析医药价格综合改革对住院费用及其结构的影响,评价改革成效并提出政策建议。
      方法   以冠心病患者为例,采用整群抽样的方法,选取新疆某三甲医院2017年9月 — 2018年8月的病历数据1 905例为实验组,2016年9月 — 2017年8月的病历数据3 592例为对照组,采用非参数检验、分位数回归方法分析住院各项费用变化情况及其影响。
      结果   2组次均费用、自付费用、材料费用、药品费用等各项费用比较,差异均有统计学意义(P < 0.05);分位数回归分析显示,时间变量除在自付费用的P75分位点、药品费用P25分位点和其他费用P50分位点上无影响(P > 0.05)外,对其他费用P25分位点及诊疗费用和护理费用各分位点均产生正性影响(P < 0.05),而对其余各项费用各分位点均有负性影响(P < 0.05)。保险类型除对药品、诊疗、检查和其他费用的P25分位点无影响(P > 0.05)外,对其余分位点及各项费用各分位点均有正性影响(P < 0.05)。住院天数对各项费用各分位点均有正性影响(P < 0.05)。
      结论   医药价格综合改革总体降低了患者的负担,提升了医护人员的劳动价值,但改革还须关注高自付费用项目,加强保险机构的同质化管理。

     

    Abstract:
      Objective   To analyze the influence of comprehensive medicine price reform on amount and structure of hospitalization expenses using quantile regression model for evaluating the effectiveness of the reform and making policy recommendations.
      Methods   Using cluster sampling, we extracted the data on 1 905 coronary disease patients hospitalized during September 2017 – August 2018 and 3 592 hospitalized during September 2016 – August 2017 in a grade A tertiary hospital in Xinjiang Uygur Autonomous Region as the experiment and the control group. Non-parametric test and quantile regression were used to analyze changes in hospitalization expenses and effects of medicine price reform.
      Results   There were significant discrepancies in average hospitalization expenses per hospitalization, out-of-pocket expenses, material expenses, drug expenses and other expenses between the two groups (P < 0.05 for all). The results of quantile regression analysis demonstrated that the time variable exerted a significant effect on all quantile values of expenses of all items (including positive effect on all quantile values of diagnosis, treatment, and nursing expenses and on 0.25 quantile value for other expenses, but negative effect on all quantile values of expenses of all remaining items, P < 0.05 for all) except for 0.75 quantile value for out-of-pocket expenses, 0.25 quantile value for drug expenses and 0.50 quantile value for other expenses (P > 0.05 for all); the type of medical insurance showed a significant effect on all quantile values of expenses of all items (P < 0.05 for all) but no significant effect on the 0.25 quantile values of expenses for drug, diagnosis/treatment, check-up, and other expenses (all P > 0.05); duration of hospitalization had a significant positive effect on all quantile values of expenses for all items (P < 0.05 for all).
      Conclusion   The comprehensive medicine price reform has generally reduced hospitalization expenses of patients but special attention should be paid in the reform to items with high out-of-pocket expenses and homogenized management of insurance institutions.

     

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