Meerding Willem Jan, Mulder Saakje, van Beeck Ed F
Department of Public Health, Erasmus MC, Rotterdam, The Netherlands.
Eur J Public Health. 2006 Jun;16(3):272-8. doi: 10.1093/eurpub/ckl006. Epub 2006 Feb 13.
Injuries are a major and persistent public health problem, but a comprehensive and detailed overview of the economic burden is missing. We therefore estimated the number of emergency department (ED) attendances and health care costs as a result of injury.
We estimated lifetime health care costs of injuries occurring in The Netherlands in the year 1999. Patient groups were defined that are homogeneous in terms of health service use. Health service use and costs per patient group was estimated with data from national databases and a prospective study among 5755 injury patients.
Total health care costs due to injury in 1999 were euro 1.15 billion, or 3.7% of the total health care budget. Major cost peaks were observed among males between ages 15 and 44 due to a high incidence, and among females from age 65 onwards due to a high incidence and high costs per patient. For the age groups 0-14, 15-44, 45-64, and 65+ ED attendances per 1000 person years were 85, 85, 43, and 49, respectively, and costs per capita were euro 38, euro 59, euro 43, and euro 210, respectively. Costs per patient rise about linearly up to age 60 and about exponentially thereafter. From age 25 onwards, females have higher costs per patient than males. Hip fracture (20%), superficial injury (13%), open wounds (7%), and skull-brain injury (6%) had the highest total costs. Most costs were attributable to falls (44%) and traffic injuries (19%).
Young adult males, elderly females, falls, hip fractures, and minor injuries without medical need for hospitalization account for a substantial share of health care costs.
伤害是一个重大且长期存在的公共卫生问题，但目前缺少对其经济负担的全面详细概述。因此，我们估算了因伤害导致的急诊科就诊次数和医疗费用。
我们估算了1999年荷兰发生的伤害的终生医疗费用。根据医疗服务使用情况定义了患者群体。利用国家数据库数据以及对5755名受伤患者的前瞻性研究，估算了每个患者群体的医疗服务使用情况和费用。
1999年因伤害产生的总医疗费用为11.5亿欧元，占医疗总预算的3.7%。15至44岁男性因发病率高出现主要费用高峰，65岁及以上女性因发病率高且每位患者费用高出现主要费用高峰。对于0至14岁、15至44岁、45至64岁和65岁及以上年龄组，每1000人年的急诊科就诊次数分别为85次、85次、43次和49次，人均费用分别为38欧元、59欧元、43欧元和210欧元。每位患者的费用在60岁之前大致呈线性上升，此后大致呈指数上升。从25岁起，女性每位患者的费用高于男性。髋部骨折（20%）、浅表损伤（13%）、开放性伤口（7%）和颅脑损伤（6%）的总费用最高。大部分费用归因于跌倒（44%）和交通伤害（19%）。
年轻成年男性、老年女性、跌倒、髋部骨折以及无需住院治疗但有医疗需求的轻伤占医疗费用的很大一部分。
