Bi S H, Li Z F, Wang T, Wang Y, Zhang C, Ji H, Shi J
Division of Nephrology, Peking University Third Hospital, Beijing 100191, China.
School of Economics, Peking University, Beijing 100871, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2020 Nov 4;53(1):215-219. doi: 10.19723/j.issn.1671-167X.2021.01.033.
To investigate trends in hospitalization expenditures in adults with kidney disease, to analyze the time pattern of outpatient and inpatient medical expenditures for patients with kidney diseases, and to support the health care reform by exploring the causes.
Medical expenditure data for kidney disease patients aged ≥18 years from the outpatient and in-patient data of the information center in the Grade?A tertiary hospital in Beijing, China from January 1, 2012, to December 31, 2017, were retrospectively analyzed. It provided descriptive evidence on the time patterns of expenditures per visit and capita, and potential influencing factors of the time changes were further explored.
It was found that medical expenditures had increased rapidly from 2012 to 2017. The result showed that the average outpatient expenditure per capita for kidney disease patients was 4 598 yuan in 2012, with an increasing tendency to 11 536 yuan in 2017. There was an obvious increase in the average number of visits (per year) from 3.94 in 2012 to 9.11 in 2017. Meanwhile, the mean inpatient expenditures per capita had an increasing tendency from 323 753 yuan in 2012 to 45 904 yuan in 2017. There was also an increase of mean inpatient expenditures per admission from 27 184 yuan in 2012 to 34 933 yuan in 2017, with a similar number of admissions over the 6 years. The increases in outpatient and inpatient expenditures per capita were driven by different reasons. The increase in outpatient expenditures per capita was driven by the increase of patient visits, while the increase in inpatient expenditures per capita was driven by the increase of the expenditures per admission. Also, drug and medical materials were the two categories that had the largest contribution to the inpatient expenditures. Drug expenses were the highest one, with an average of 12 524 yuan per visit in 2017, accounting for 32.4% of the average total expenditure in that year, while the average cost of consumables was 9 215 yuan, accounting for 23.9%.
The increase of outpatient expenditures per capita was related to the increase of patient visits. Meanwhile, the growth of drug and consumable costs contributed to the total increase in the total inpatient healthcare costs. It is necessary to increase the proportion of treatment costs and medical service fees in the total expenditure.
探讨成人肾病患者住院费用的变化趋势，分析肾病患者门诊和住院医疗费用的时间模式，并通过探究原因来支持医疗改革。
回顾性分析了中国北京某三甲医院信息中心2012年1月1日至2017年12月31日≥18岁肾病患者的门诊和住院医疗费用数据。提供了每次就诊和人均费用时间模式的描述性证据，并进一步探究了时间变化的潜在影响因素。
发现2012年至2017年医疗费用迅速增加。结果显示，2012年肾病患者人均门诊费用为4598元，到2017年呈上升趋势，达到11536元。每年平均就诊次数从2012年的3.94次明显增加到2017年的9.11次。同时，人均住院费用呈上升趋势，从2012年的323753元增加到2017年的45904元。每次住院的平均住院费用也从2012年的27184元增加到2017年的34933元，6年间住院次数相似。人均门诊和住院费用的增加由不同原因驱动。人均门诊费用的增加是由患者就诊次数增加驱动的，而人均住院费用的增加是由每次住院费用的增加驱动的。此外，药品和医疗耗材是对住院费用贡献最大的两类。药品费用最高，2017年每次就诊平均为12524元，占当年平均总支出的32.4%，而耗材平均费用为9215元，占23.9%。
人均门诊费用的增加与患者就诊次数的增加有关。同时，药品和耗材成本的增长导致了住院医疗总费用的总体增加。有必要提高治疗费用和医疗服务费在总支出中的比例。
