Department of Nursing, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital, 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China.
Department of Nursing, Henan Provincial People's Hospital, No.7 Weiwu Road, Jinshui District, Zhengzhou, 450003, China.
BMC Health Serv Res. 2020 Sep 29;20(1):905. doi: 10.1186/s12913-020-05758-6.
In this study, we aimed to analyze the hospitalization costs for immobile patients with hemorrhagic stroke (IHS) or ischemic stroke (IIS) in China and to determine the factors associated with hospitalization costs.
We evaluated patients with IHS and IIS hospitalized between November 2015 and July 2016 in six provinces or municipality cities of China. Linear regression analysis was used to examine the association with hospitalization costs and predictors.
In total, 1573 patients with IHS and 3143 with IIS were enrolled and analyzed. For IHS and IIS, the average length of stay (LoS) was 17.40 ± 12.3 and 14.47 ± 11.55 days. The duration of immobility was 12.11 ± 9.98 and 7.36 ± 9.77 days, respectively. Median hospitalization costs were RMB 47000.68 (interquartile range 19,827.37, 91,877.09) for IHS and RMB 16578.44 (IQR 7020.13, 36,357.65) for IIS. In both IHS and IIS groups, medicine fees accounted for more than one-third of hospitalization costs. Materials fees and medical service fees accounted for the second and third largest proportions of hospital charges in both groups. Linear regression analysis showed that LoS, hospital level, and previous surgery were key determinants of hospitalization costs in all immobile patients with stroke. Subgroup analysis indicated that hospital level was highly correlated with hospitalization costs for IHS whereas pneumonia and deep vein thrombosis were key factors associated with hospitalization costs for IIS.
We found that hospitalization costs were notably higher in IHS than IIS, and medicine fees accounted for the largest proportion of hospitalization costs in both patient groups, perhaps because most patients ended up with complications such as pneumonia thereby requiring more medications. LoS and hospital level may greatly affect hospitalization costs. Increasing the reimbursement ratio of medical insurance for patients with IHS is recommended. Decreasing medicine fees and LoS, preventing complications, and improving treatment capability may help to reduce the economic burden of stroke in China.
本研究旨在分析中国卧床不动的脑出血（IHS）或缺血性脑卒中（IIS）患者的住院费用，并确定与住院费用相关的因素。
我们评估了 2015 年 11 月至 2016 年 7 月期间在中国六个省或直辖市住院的 IHS 和 IIS 患者。线性回归分析用于检查与住院费用和预测因子的关联。
共纳入并分析了 1573 例 IHS 和 3143 例 IIS 患者。对于 IHS 和 IIS，平均住院时间（LoS）分别为 17.40±12.3 和 14.47±11.55 天。活动受限时间分别为 12.11±9.98 和 7.36±9.77 天。IHS 的中位住院费用为人民币 47000.68 元（四分位距 19827.37 元，91877.09 元），IIS 的中位住院费用为人民币 16578.44 元（四分位距 7020.13 元，36357.65 元）。在 IHS 和 IIS 组中，药品费用占住院费用的三分之一以上。材料费用和医疗服务费用在两组的住院费用中占第二和第三大比例。线性回归分析表明，LoS、医院级别和既往手术是所有脑卒中卧床患者住院费用的关键决定因素。亚组分析表明，医院级别与 IHS 的住院费用高度相关，而肺炎和深静脉血栓形成是 IIS 住院费用相关的关键因素。
我们发现 IHS 的住院费用明显高于 IIS，药品费用占两组患者住院费用的最大比例，这可能是因为大多数患者最终出现肺炎等并发症，因此需要更多的药物治疗。LoS 和医院级别可能会极大地影响住院费用。建议增加 IHS 患者医疗保险的报销比例。降低药品费用和 LoS、预防并发症以及提高治疗能力可能有助于减轻中国脑卒中的经济负担。
