Tu Feng, Anan Makoto, Kiyohara Yutaka, Okada Yasushi, Nobutomo Koichi
Department of Health Services Management and Policy, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Health Policy. 2003 Dec;66(3):239-46. doi: 10.1016/s0168-8510(03)00080-0.
Stroke is a heavy economic burden on individuals, society, and health services in Japan, where health expenditures are rising rapidly. The objective of the present study was to examine medical services and demographic factors associated with increased inpatient charges for ischemic stroke in Japan.
The study subjects were 316 patients with a principal diagnosis of acute ischemic stroke who were discharged from the National Kyushu Medical Center Hospital from 1 July 1995 through 31 June 1999. Demographic, clinical, and administrative data were retrospectively collected from medical records and the hospital Clinical Financial Information System (CFIS). The influence of social and medical factors on total charges was analyzed using the stepwise multiple regression model.
Among the total subjects, the mean (median) length of hospital stay (LOHS) was 33 (30) days (range, 2-155 days). The mean (median) hospital charge per patient was US dollars 9020 (dollars 7974) with a range of dollars 336-54,509. The distribution of charges was 42% for fundamental, 17% for injection therapies, 13% for radiological test, 11% for other laboratory examinations, 3% for drugs, and 3% for operations. Stepwise multiple regression analysis revealed that LOHS was the key determinant of the hospital charge (partial R2=0.5993, P=0.0001). Operations (P=0.0001) and angiography (P=0.03) were also independent but less contributory determinants of the hospital charge.
LOHS was strongly, positively associated with inpatient charges for ischemic stroke in Japan. This implies that significant charge reductions are more likely to rely on shortening LOHS, which probably can be achieved by altering reimbursement policies.
在日本，卒中给个人、社会和医疗服务带来了沉重的经济负担，且卫生支出正在迅速增长。本研究的目的是调查与日本缺血性卒中住院费用增加相关的医疗服务和人口统计学因素。
研究对象为1995年7月1日至1999年6月31日从国立九州医疗中心医院出院的316例主要诊断为急性缺血性卒中的患者。从病历和医院临床财务信息系统（CFIS）中回顾性收集人口统计学、临床和管理数据。使用逐步多元回归模型分析社会和医疗因素对总费用的影响。
在所有研究对象中，平均（中位数）住院时间（LOHS）为33（30）天（范围为2 - 155天）。每位患者的平均（中位数）住院费用为9020美元（7974美元），范围为336 - 54509美元。费用分布为基础费用占42%，注射治疗占17%，放射检查占13%，其他实验室检查占11%，药物占3%，手术占3%。逐步多元回归分析显示，住院时间是住院费用的关键决定因素（偏R2 = 0.5993，P = 0.0001）。手术（P = 0.0001）和血管造影（P = 0.03）也是住院费用的独立但贡献较小的决定因素。
在日本，住院时间与缺血性卒中的住院费用呈强烈正相关。这意味着大幅降低费用更有可能依赖于缩短住院时间，而这可能通过改变报销政策来实现。
