摘要
目的
针对乳腺癌患者住院医疗费用快速增长的现状，对河南省某三甲医院2013~2016年出院乳腺癌患者的医疗费用资料进行研究，分析并找出影响乳腺癌患者住院医疗费用增长的主要因素。结合相关文献及政策，提出合理的措施，为控制乳腺癌住院医疗费用提供科学的参考依据。
方法
采用回顾性调查研究方法，在医院信息数据库中抽取2013年7月到2016年6月出院的10779例乳腺癌患者的基本资料，建立Excel数据库，运用SPSS21.0软件进行非参数检验和多重线性回归分析，对乳腺癌患者住院费用构成及影响因素进行分析。
结果
1. 乳腺癌患者的平均年龄为48.92岁；无业人员的例数最多，为3374例，占总例数的31.30%；全自费和新型农村合作医疗的患者比例分别为60.69%和26.83%。干豆角
2. 本研究中有合并症的乳腺癌患者占总数的10.67%；所有乳腺癌患者的平均住院天数为11.42天，手术
治疗患者的平均住院天数为17.19天；早期的乳腺癌患者有2641例，仅占24.50%；而晚期患者占75.5%；有4177例患者接受手术治疗，6602例患者选择非手术治疗。
3. 乳腺癌住院患者的平均医疗费用为16261.72元，平均药品费用为5941.00元；药占比为36.53%，技术性服务收费所占比例仅为7.52%。不同年份的住院费用呈逐年下降趋势，其差别具有统计学意义(χ2=153.541，P＜0.001)；不同婚姻状况的患者住院费用没有显著差异(χ2=0.683，P＞0.05)；不同职业构成的患者住院费用具有显著性差异(χ2=32.925，P＜0.001)；不同医疗保障制度的患者住院
费用有显著性差异(χ2=385.250，P＜0.001)。
4. 不同的肿瘤分期与平均住院费用呈正相关，肿瘤分期越高费用越高(χ2=568.236，P＜0.001)；有合并症的患者住院平均费用高于无合并症的患者(χ2=52.822，P＜0.001)；不同住院天数的乳腺癌住院患者医疗费用具有显著差异(χ2=7166.897，P＜0.001)；手术治疗患者的平均住院费用高于非手术治疗患者(χ2=79.222，P＜0.001)。
5. 多重线性回归分析显示影响乳腺癌患者住院费用的因素分别为：住院天数、合并症、是否手术、出院年份、手术方式、医疗保障制度、肿瘤分期。
6. 按疾病分组将乳腺癌患者分为4组：手术组有合并症、手术组无合并症、非手术组肿瘤早期、非手术组肿瘤晚期，各组的预测人均费用依次为28000元、26000元、5500元、7200元。
属鸡的财运结论
1. 影响乳腺癌治疗费用的主要因素是住院天数、合并症、肿瘤分期及是否手术。对乳腺癌患者进行早期诊断和早期治疗对降低住院费用有积极意义，并可改善预后。
2. 乳腺癌患者住院费用构成不合理，药品费用比例较高，体现医疗人员技术价值的服务项目费用比例较低。
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3. 通过建立乳腺癌疾病分组模型及对各组人均住院费用的预测分析，可以为相关部门制定收费标准提供参考依据，在保证医院收入的前提下有效控制住院费用的不合理增长。
关键词：乳腺癌住院费用影响因素
Abstract
Objective
For the current situation of the rapid growth in hospitalization costs of breast cancer inpatients, this study analyzes the data of the hospitalization costs of the breast cancer inpatients in a tertiary level first--class hospital from 2013 to 2016. It finds out the main factors of affecting the hospitalization cos
蝉的外形特征ts of the breast cancer inpatients. With looking up the related literature and policy, this study put forward the reasonable measures, which provides the scientific and valuable references for controlling the growth of hospitalization costs of the breast cancer.
Methods
The retrospective review is ud in this study to analyze the influence factors of the breast cancer inpatients, combined with the basic information of extracting from the breast cancer inpatients, 10,779 cas, left the hospital from July 2013 to June 2016. This study ts up the databa with excel, and u the SPSS21.0 to do the non-parametric test and multiple linear regression analysis.
Results
1.The average age of the breast cancer is at the age of 48.92, and the number of the
unemployed people is large, 3374, the percentage is 31.30%；the percentages of the lf-paying patients and new rural co-operative medical patients are 60.69% and 26.83%.
2.The complication inpatients with breast cancer accounts for 10.67% of the total
inpatients; the average days for all inpatients were 11.42 days; the
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average days for the surgical patients were 17.19; the number of the early patients of breast cancer were 2,641, accounting for 24.50%; the terminal-stage cancer patients were 75.5%. There were 4177 patients to accept the operative treatment, and there were 6602 patients to choo the non-surgical treatment.
3.The average medical expen of hospitalized patients with breast cancer was
1,6261,72 RMB. The average medicine expen was 5, 941.00 RMB, the medicine accounted for 36.53%; the technical rvice charge proportion was 7.52%. The hospitalization cost in different years showed the declining trend year by year, the difference among them has the statistical value (χ2 = 153.541, P < 0.001); However, there was no significant difference in the hospitalization expens between different marital status (χ2=0.683, P＞0.05), and the hospitalization expens of different occupational structure has a significant difference (χ2=32.925, P＜0.001); the hospitalization expens of patients with different payment methods has significant difference (χ2=385.250, P＜0.001).五年级读书卡
4.The different clinical stages were positively correlated with the average
hospitalization expens. The higher the tumor stage had, the more expensive the cost were (χ2=56
8.236, P＜0.001) ; the average hospitalization cost of the complications patients was higher than the non- complications (χ2=52.822, P＜
0.001); the hospitalization costs of breast cancer patients with different days in
hospital has significant difference (χ2=7166.897,P＜0.001);the average hospitalization cost of the surgical patients was higher than the non-surgical patients (χ2=79.222, P＜0.001).
5.The multiple linear regression analysis shows that the factors influencing the
hospitalization cost of the breast cancer inpatients are the days of hospital stay, the
complications, surgical options, year of leaving the hospital, operation method, and patterns of payment, and discharge time.
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6.The breast cancer patients could be divided into four groups by dias, the
surgical complications, surgical group without complications, early non-surgical patients, and the terminal non-surgical patients. The predicted per capita cost of each group in quence is 28, 000 RMB, 26,000 RMB, 5,500 RMB, 7,200 RMB.
Conclusion
1.The main factors influencing the hospitalization cost of the breast cancer are the
days of hospital stay, the complications, clinical tumor stage, and surgical options.
It has positive significance for the breast cancer patients to get early diagnosis and early treatment, which could reduce the hospitalization expens and improve the prognosis.
2.The expenditure pattern is not reasonable, the proportion of the medicine costs was
high, which reflected that the rvices projects cost of medical personnel technical value is lower.
3.It could provide the reference frame for the relevant departments to make the
长山药炒木耳charge standard, according to the establishment of the group model for the breast cancer dia and the predicted analysis of per capita cost of each group. On the premi of guaranteeing the hospital income, it also could control the unreasonable growth of hospitalization expen.
Key words：breast cancer; hospitalization costs; influence factors
