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

References 27

[1]	SEELMAN K D. The World Health Organization/World Bank's First World Report on Disability[J]. Int J Telerehabil, 2011, 3(2): 11-14. doi: 10.5195/ijt.2011.6076 pmid: 25945184
[2]	WANG C, LI F, WANG L, et al. The impact of population aging on medical expenses: a big data study based on the life table[J]. Biosci Trends, 2017, 11(6): 619-631. doi: 10.5582/bst.2017.01243
[3]	张盘德, 张薇平. 综合医院康复科住院患者分析[J]. 中华物理医学与康复杂志, 2006, 28(10): 681-685.
	ZHANG P D, ZHANG W P. Analysis of in-patients in the rehabilitation department of a general hospital[J]. Chin J Phys Med Rehabil, 2006, 28(10): 681-685.
[4]	高姣姣, 宋玉磊, 柏亚妹, 等. 呼吸系统感染患者住院费用灰色关联及影响因素分析[J]. 中国医院, 2024, 28(2): 20-23.
	GAO J J, SONG Y L, BAI Y M, et al. Analysis of gray correlation and influencing factors of hospitalization expenses for patients with respiratory infection[J]. Chin Hosp, 2024, 28(2): 20-23.
[5]	权佩钦, 胡晓斌, 王聪, 等. 2014-2018年甘肃省糖尿病患者住院费用变化趋势及影响因素分析[J]. 中国慢性病预防与控制, 2022, 30(1): 8-13.
	QUAN P Q, HU X B, WANG C, et al. The trend of hospitalization expenditure and its influencing factors of patients with type 2 diabetes mellitus in Gansu Province from 2014 to 2018[J]. Chin J Prev Control Chronic Non-Commun Dis, 2022, 30(1): 8-13.
[6]	苏飞月, 符美玲, 谭慭莘, 等. 基于分位数回归与决策树模型的跌倒患者住院费用影响因素分析[J]. 中国卫生统计, 2021, 38(1): 67-72.
[7]	张雪玉, 王莉, 罗璇, 等. 基于面板分位数回归的老年糖尿病足患者治疗费用影响因素分析[J]. 中国卫生统计, 2019, 36(6): 893-895.
[8]	OLSEN M A, TIAN F, WALLACE A E, et al. Use of quantile regression to determine the impact on total health care costs of surgical site infections following common ambulatory procedures[J]. Ann Surg, 2017, 265(2): 331-339. doi: 10.1097/SLA.0000000000001590 pmid: 28059961
[9]	杨帆, 吕翔, 童雪君. 医保支付方式改革下冠心病患者住院费用构成对总费用的影响研究[J]. 中国社会医学杂志, 2023, 40(6): 721-724.
	YANG F, LÜ X, TONG X J. Study on the impact of inpatient cost components on the total cost of coronary heart disease patients under the medical insurance payment reform[J]. Chin J Soc Med, 2023, 40(6): 721-724.
[10]	张自严, 冯丹, 王嘉年, 等. 浙江某三甲医院糖尿病患者次均住院费用及药占比时间序列预测分析[J]. 现代医院, 2023, 23(12): 1861-1865, 1870.
	ZHANG Z Y, FENG D, WANG J N, et al. Time series prediction analysis of average hospitalization expenditure and drug proportion of diabetes patients in a grade-a tertiary hospital in Zhejiang province[J]. Modern Hosp, 2023, 23(12): 1861-1865, 1870.
[11]	王磊, 杨娅娅, 赵怡妮, 等. 基于分位数回归和随机森林的老年伤害患者住院费用影响因素分析[J]. 中国慢性病预防与控制, 2023, 31(4): 246-250.
	WANG L, YANG Y Y, ZHAO Y N, et al. Analysis of influencing factors of hospitalization expenses in elderly patients with injury based on quantile regression and random forest[J]. Chin J Prev Control Chronic Non-Commun Dis, 2023, 31(4): 246-250.
[12]	李令岭, 刘垚, 敖丽娟. 我国残疾人社区康复存在问题与发展探讨[J]. 中国康复医学杂志, 2017, 32(2): 213-216.
[13]	DING J M, ZHANG X Z, HU X J, et al. Analysis of hospitalization expenditures and influencing factors for inpatients with coronary heart disease in a tier-3 hospital in Xi'an, China: a retrospective study[J]. Medicine (Baltimore), 2017, 96(51): e9341. doi: 10.1097/MD.0000000000009341
[14]	刘春, 王怀斌, 吴佳. 基于DRGs的三级综合医院2型糖尿病患者住院费用标准研究[J]. 中国卫生统计, 2024, 41(1): 139-142.
[15]	黄娟. 北京市某三甲医院慢性阻塞性肺疾病住院患者直接经济负担影响因素分析[J]. 医学与社会, 2015, 28(7): 19-22.
	HUANG J. Analysis on direct economic burden of hospitalized patients with COPD and its influencing factors in a three-level Hospital in Beijing[J]. Med Soc, 2015, 28(7): 19-22.
[16]	刘京宇, 杨延砚, 张元鸣飞, 等. 2022年度国家康复医疗服务与质量安全报告[J]. 中国康复理论与实践, 2024, 30(2): 125-140. doi: 10.3969/j.issn.1006-9771.2024.02.001
	LIU J Y, YANG Y Y, ZHANG Y M F, et al. 2022 Country Report on Medical Rehabilitation Services, Quality and Safety in Health Care System[J]. Chin J Rehabil Theory Pract, 2024, 30(2): 125-140.
[17]	张元鸣飞, 樊静, 周谋望, 等. 2013-2018年国家三级医院康复医学科住院患者医疗服务与质量安全报告:基于医院质量监测系统病案首页数据[J]. 中国康复医学杂志, 2020, 35(7): 771-774.
[18]	中共中央国务院关于深化医疗保障制度改革的意见[J]. 中华人民共和国国务院公报, 2020(9): 10-15.
[19]	林敏, 夏燕, 朱婷, 等. DRG付费改革对医院运营效率的影响研究[J]. 卫生经济研究, 2021, 38(12): 62-65.
	0425LIN M, XIA Y, ZHU T, et al. Research on the Influence of DRG Payment Reform on Hospital Operation Efficiency[J]. Health Econ Res, 2021, 38(12): 62-65.
[20]	陈红光, 王廷伟, 韩晶, 等. 农村重大疾病流行特征及其住院医疗费用分析[J]. 中国公共卫生, 2020, 36(1): 115-119.
	CHEN H G, WANG T W, HAN J, et al. Major disease-specific hospitalizations and their expenses among rural residents covered by NRCMS in Yulin city of Shaanxi province[J]. Chin J Public Health, 2020, 36(1): 115-119.
[21]	高新才, 金梅. 人口与资源环境视角的甘肃经济发展方式研究[J]. 西北人口, 2013, 34(5): 82-86.
[22]	方亚琼, 黄朝荣, 王斌雄, 等. 优劣解距离法结合秩和比法综合评价甘肃省二级综合医院康复医疗服务质量[J]. 中国康复医学杂志, 2021, 36(6): 713-718.
[23]	杜晓莉, 王秋霞, 刘斌, 等. 重庆市医联体内分级诊疗效果研究——以糖尿病诊疗为例[J]. 卫生经济研究, 2019, 36(4): 31-33.
	DU X L, WANG Q X, LIU B, et al. Study on the effect of grading diagnosis and treatment in Chongqing Medical Association: taking diabetes diagnosis and treatment as an example[J]. Health Econ Res, 2019, 36(4): 31-33.
[24]	闫宣辰, 姚进文, 路杰, 等. 甘肃省分级诊疗对慢性病管理的效果评价:以高血压和糖尿病为例[J]. 中国卫生质量管理, 2019, 26(1): 113-116.
	YAN X C, YAO J W, LU J, et al. Effectiveness of hierarchical diagnosis and treatment in Gansu Province on optimizing chronic diseases management: taking hypertension and diabetes as examples[J]. Chin Health Qual Manag, 2019, 26(1): 113-116.
[25]	舒晓, 杨子敬, 周玉兰, 等. 2957例痴呆患者住院费用影响因素分析[J]. 中国病案, 2023, 24(6): 90-93.
	SHU X, YANG Z J, ZHOU Y L, et al. Analysis on influencing factors of hospitalization cost of patients with Alzheimer's disease[J]. Chin J Med Cases, 2023, 24(6): 90-93.
[26]	杜杏利, 高欢, 李卉, 等. 国内外医联体及分级诊疗构建模式对比与思考[J]. 中国医院, 2017, 21(12): 40-42.
	DU X L, GAO H, LI H, et al. Comparison and consideration of the model of healthcare alliance based hierarchical medical system mode internal and abroad[J]. Chin J Hospital Statistics, 2017, 21(12): 40-42.
[27]	潘翠环, 邢洲, 林志彤, 等. 广州市康复医疗服务双向转诊试点及成效探析[J]. 中国康复医学杂志, 2016, 31(1): 91-92.

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

RichHTML

PDF (PC)

Knowledge

Abstract

Cite this article

share this article

Figures/Tables 3

References 27

Related Articles 15

Metrics

Comments

Recommended 0

[1]	ZHANG Qing, LI Yanqun, JIA Wenrong, LIU Qiaoyun, JIANG Ruilin. Research on framework, core content and priority areas of international policy of healthcare, rehabilitation and education services for children with hearing and speech impairments [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(4): 373-380.
[2]	LENG Qing, ZHANG Ying, ZHANG Weifeng. Survey on competency status of hearing and speech rehabilitation professionals in Jiangsu, China [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(4): 389-396.
[3]	YANG Rong, WANG Qian, ZI Yang, CHEN Yiting, LI Yingcai, LENG Jun. Brain-computer interface technology used in rehabilitation medicine in the last decade: a visualized analysis [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(4): 416-423.
[4]	ZHENG Jianling, LIU Huilin, ZHU Lin, GU Bin, YAN Ruxiu, ZHAO Qi, SONG Luping. Effect of early intelligent assisted walking under suspension protection on motor and walking function for stroke patients [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(4): 431-436.
[5]	ZHANG Zhiliang, CHU Hongling, LIU Xiaoxie, ZHOU Mouwang, ZHOU Feifei. Application of early intensive rehabilitation in enhanced recovery after surgery protocol after laminoplasty: a mixed methods research [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(4): 468-478.
[6]	HUANG Longxian, ZUO Yan, CHEN Limei, GU Sijia, JIANG Jinmei, ZHANG Zhiwei. Aspiration after dysphasia in recent twenty years: a visualized analysis [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(3): 292-302.
[7]	LIU Huan, HAN Xue, SONG Jianing, LOU Xiaole, XU Lei. Effect of robotic training under position limitation on upper limbs in patients with shoulder subluxation after stroke [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(3): 303-309.
[8]	ZHU Lan, GUO Chuan, HUANG Sisi, JI Panpan, CHENG Yihui, SHEN Ying. Application of seminar in addition to case-based learning in physical therapy practical teaching [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(3): 368-372.
[9]	LIU Jingyu, YANG Yanyan, ZHANG Yuanmingfei, LIU Xiaoxie, ZHANG Na, ZHANG Zhiliang, ZHOU Mouwang. 2022 Country Report on Medical Rehabilitation Services, Quality and Safety in Health Care System [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(2): 125-140.
[10]	WU Liang, XU Xiu, LUO Liang. Effect of exercise rehabilitation and adapted physical activity on psychomotor skills, motor abilities and motor development in children and adolescents with spastic cerebral palsy: an evidence-based research using ICF [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(2): 148-156.
[11]	YANG Yaru, YANG Jian, QIU Zhuoying, QIU Fubing, XIAO Xiaofei, PENG Yifeng. Research on community-based rehabilitation exercise and physical activity and its benefits for people with mild and moderate disability in Shenzhen, Guangdong, China [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(2): 189-194.
[12]	LI Fang, LIU Huizhen, MEI Liping, ZHANG Tong, ZHANG Haojie, LI Bingjie, ZHAO Jun. Related factors of post-stroke depression in patients with cerebral infarction during hospitalization in rehabilitation department [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(2): 217-222.
[13]	XU Zhou, ZHENG Jiejiao, DING Jianwei, ZHANG Jie. Effect of core muscles training based on spinal fine-tuning manipulation on lumbar spine function and quality of life in patients with lumbar facet joint disorders [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(2): 238-242.
[14]	LUO Lihua, WANG Yusheng, LI Jianfeng, DONG Jige. Effect of early postoperative comprehensive rehabilitation on children and youth with supracondylar fracture of humerus complicated with ulnar nerve injury [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2024, 30(1): 105-110.
[15]	WANG Zihao, LI Xinhua, JIANG Huiping, GUO Sainan, LIANG Qiuman, SHI Tingqi. Short-term knee function after total knee arthroplasty and related factors [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2024, 30(1): 111-118.