康复患者次均住院费用影响因素的分析：基于分位数回归模型

doi:10.3969/j.issn.1006-9771.2024.04.004

Abstract

Abstract:

Objective To analyze the distribution and the influcing factors of the average hospitalization costs of rehabilitation inpatients of secondary and tertiary hospitals in Gansu Province.

Methods The medical records of 6 950 rehabilitation inpatients from January 1st, 2017 to June 30th, 2023 from 59 secondary and tertiary hospitals in Gansu Province were selected by stratified sampling. The home pages of inpatient medical records were collected through the electronic medical record management system. The distribution and characteristics of the average hospitalization costs of rehabilitation patients were described, and the influencing factors of the average hospitalization costs were analyzed by quantile regression model.

Results The average hospitalization cost was 6 282.65 (4 095.39, 11 829.36) yuan per admission. Multivariate analysis showed that the age (β > 21.509), length of stay (β > 166.320), hospital level (β > 1096.971), hospital category (|β| > 969.080), admission pathway (β > 307.731), inter-department transference (β > 732.289) and medication use (β > 737.109) effected the three quantile points (P₁₀, P₅₀, P₉₀) of the average hospitalization costs (P < 0.05), the strongest on the highest quantile point. The average hospitalization costs of rehabilitation inpatients admitted from 2017 to 2019 were lower than that admitted from 2020 to 2023 at the 10th quartile point (β= -732.341), but higher at the 90th quartile point (β = 846.445) (P < 0.05). Compared with self-payment, the average hospitalization costs of rehabilitation inpatients paid by medical insurance were higher at the 10th quartile point (β_staff = 450.606, β_resident = 478.421), lower at the 90th quartile point (β_staff= -2517.823, β_resident = -1283.355) (P < 0.05). Compared with other types of diseases, mental and behavioral disorders and neurological diseases cost less (β <-569.500), while circulatory diseases cost more at the 10th quartile point (β= 457.393); and musculoskeletal and connective tissue diseases cost less at the 50th (β= -1106.791) and 90th (β= -3072.947) quartile point (P < 0.05).

Conclusion The average hospitalization cost varies greatly among different rehabilitation patients, and the influencing factors are complex. Compared with self-payment, medical insurance plays a protective role on the high quantile point of the average hospitalization costs.

Key words: hospitalization cost, rehabilitation, influencing factors, quantile regression

CLC Number:

JIANG Na, WEI Ning, ZENG Yanling, ZHANG Qian, YI Xiaozhe, CHEN Wanqiang, JING Yuzhen, JI Jing, GUO Xusheng, PEI Hongbo, WANG Jianyun. Influencial factors of average hospitalization costs of rehabilitation inpatients based on quantile regression model[J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(4): 397-403.

Figures/Tables 3

Table1

Table 2

Univariate analysis of average hospitalization cost for rehabilitation inpatients (n = 6 950)"

指标名称	分组	n	次均住院费用/元	H/Z值	P值
经济分区	一类	2599	7540.00(4579.25, 11416.28)	64.349^d	< 0.001
	二类	1336	5684.93(3738.47, 10469.52)
	三类	1470	6765.73(4126.09, 11039.56)
	四类	1545	6463.62(3796.33, 16904.89)
医院级别	三级	4647	8601.58(5580.38, 14243.55)	-38.273^e	< 0.001
	二级	2303	4039.00(3180.80, 5855.95)
医院类别	综合	6391	6909.22(4213.47, 11885.90)	-6.439^e	< 0.001
	专科	559	5000.00(3573.00, 10458.21)
医院所有制类型	公立	6610	6933.22(4130.83, 12000.15)	-5.724^e	< 0.001
	民营	340	5339.51(3904.75, 8316.96)
性别	男	3902	7460.17(4223.32, 12910.94)	-7.389^e	< 0.001
	女	3048	6158.26(4004.74, 10343.64)
入院途径	急诊	886	10441.33(5200.23, 22982.69)	200.852^d	< 0.001
	门诊	5997	6452.88(4020.44, 10864.49)
	其他	67	8108.38(5033.16, 19271.72)
入院年份	2017年至2019年	3997	5775.00(3773.81, 10985.20)	-13.399^e	< 0.001
	2020年至2023年	2953	7936.76(4978.40, 12593.79)
是否转科	是	465	13998.79(7408.78, 30826.16)	-16.704^e	< 0.001
	否	6485	6480.13(4023.07, 11078.47)
有出院31 d再住院计划^a	否	5739	7181.32(4485.04, 11964.11)	-2.373^e	0.018
	是	452	5967.14(3841.75, 13472.77)
医疗付费方式^b	职工医保	2195	7524.85(4839.31, 10824.16)	86.548^d	< 0.001
	居民医保	3020	5982.69(3737.29, 11416.78)
	全自费	680	8105.18(4475.63, 16826.85)
	其他	593	6766.04(4362.10, 12972.01)
是否用药	是	5606	7475.46(4428.48, 12954.99)	-17.608^e	< 0.001
	否	1344	4699.22(3592.60, 7575.03)
疾病	精神与行为障碍	331	6214.00(3875.00, 13250.29)	978.438^d	< 0.001
	神经系统疾病	1312	6894.92(4112.19, 12354.06)
	循环系统疾病	2531	8966.57(5432.43, 14863.11)
	肌肉骨骼和结缔组织疾病	1773	4550.10(3395.86, 6426.51)
	损伤、中毒和外因的某些其他后果	680	9566.42(5250.15, 17492.32)
	其他^c	323	7261.18(4298.00, 11373.51)

Table 2

Table 3

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经济分区	人均GDP水平/万元	地区
一类	≥ 7	兰州市、酒泉市、金昌市、嘉峪关市
二类	4~< 7	庆阳市、武威市、白银市、张掖市
三类	2.5~< 4	天水市、平凉市、甘南州
四类	< 2.5	陇南市、定西市、临夏州

变量	P₁₀		P₅₀		P₉₀
变量	β值	P值	β值	P值	β值	P值
年龄	21.509	< 0.001	21.554	< 0.001	29.048	< 0.001
住院时间	166.320	< 0.001	344.086	< 0.001	629.610	< 0.001
医院级别(对照=二级)
三级	1096.971	< 0.001	1956.397	< 0.001	3579.073	< 0.001
医院类别(对照=专科)
综合	969.080	< 0.001	504.912	0.004	-1912.663	< 0.001
医院所有制类型(对照=民营)
公立	183.299	0.298	270.743	0.139	1118.193	0.008
入院途径(对照=急诊)
门诊	-307.731	0.011	-1265.446	< 0.001	-14935.278	< 0.001
其他	204.560	0.600	452.987	0.263	-5042.440	< 0.001
入院年份(对照=2020年至2023年)
2017年至2019年	-732.341	< 0.001	-57.826	0.497	846.445	< 0.001
是否转科(对照=否)
是	732.289	0.010	1695.511	< 0.001	18658.357	< 0.001
医疗付费方式(对照=自费)
城镇职工基本医疗保险	450.606	< 0.001	97.351	0.497	-2517.823	< 0.001
城乡居民基本医疗保险	478.421	< 0.001	289.635	0.042	-1283.355	< 0.001
其他	402.484	0.021	433.085	0.017	-1252.558	0.002
是否用药(对照=否)
是	737.109	< 0.001	1722.059	< 0.001	2706.610	< 0.001
疾病种类(对照=其他)
精神与行为障碍	-569.500	0.035	-2177.235	< 0.001	-3384.339	< 0.001
神经系统疾病	-228.790	0.245	-1169.627	< 0.001	-3201.749	< 0.001
循环系统疾病	457.393	0.014	135.539	0.484	-346.429	0.435
肌肉骨骼和结缔组织疾病	-158.931	0.404	-1106.791	< 0.001	-3072.947	< 0.001
损伤、中毒和外因的某些其他后果	64.398	0.765	-406.293	0.069	906.186	0.076

Influencial factors of average hospitalization costs of rehabilitation inpatients based on quantile regression model

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