·医院经济管理·

外科系统感染卫生经济学评价

刘文清，李岩，李彦

(解放军第88医院，泰安271000)

[摘要]目的探讨医院感染所造成的直接经济损失情况。方法采用1∶1配对病例对照研究方法。病例组由2~86岁的111例外科系统医院感染患者组成，对照组由同期入住按年龄、性别、疾病等进行配对的111例非医院感染的患者组成。分析111对患者的医疗费用，评价医院感染的直接经济损失。结果病例组的总医疗费用的中位数为37 943.64元，是对照组的1.97倍(z=-7.179，P<0.001)。医疗费用的增加以药品费为主，其次是材料费和治疗费。病例组的平均住院日中位数为20天，比对照组的平均住院日延长8天(z=-7.088，P<0.001)。结论医院感染会大大增加医疗费用，延长患者的平均住院日、降低床位的周转、减少医院收入。因此，应逐步把医院感染造成的经济损失纳入医院感染管理的范畴，以达到提高医疗质量的目的，预防和控制医院感染必将获得社会效益和经济效益。

[关键词]医院感染；卫生经济学损失；病例对照研究

[中图分类号]R 197.32[文献标识码]A

[作者简介]刘文清，女，硕士，主任医师，副院长；电话：0538-8839567

Health Economics Evaluation of Nosocomial Infection on Surgical System

LIU Wen-qing, LI Yan，LI Yan(No.88 Hospital of PLA, Taian271000)

Abstract[]ObjectiveTo investigate the direct economic loss caused by nosocomial infections. MethodsA 1∶1 matched case-control study was conducted. Cases (n =111) were patients with nosocomial infections on surgical system from 2 to 86 years old, and controls (n =111) were patients with non-hospital infections who had been admitted to the same hospital infected by age, sex, disease, etc. By analysis among 111 pairs of patients with medical expenses, to evaluat the direct economic loss caused by nosocomial infections. ResultsThe median of total medical expenses in case group was 37 943.64 yuan, that is 1.97 times of the control group (z=-7.179, P<0.001). Drug expenses took up the largest part of the extra medical care expenses, followed by the cost of materials and treatment. The median of average hospitalization days in case group was 20 days, 8 days longer than that in the control group (z=-7.088, P<0.001). ConclusionsNosocomial infections will greatly increase health care costs, extend the average hospitalization days of patients, reduce bed turnover and lessen hospital revenue. Therefore, we should gradually bring economic loss caused by nosocomial infections into hospital management in order to improve the quality of medical care. Prevention and control of nosocomial infections will be bound to achieve significantly social and economic benefits.

[Key words]nosocomial infection; loss of health economics; case-control study

Hosp Admin J Chin PLA，2015，22(9)：883-885.

在全球范围内，医院感染已成为影响患者安全、医疗质量和增加医疗费用的重要原因。根据世界卫生组织(WHO)2005年所提供的数据：美国每年医院感染的病例高达200万例，造成超过45亿美元的额外经济损失。发达国家的研究显示[1]，每例医院感染的额外费用为1 000~4 500 美元(平均1 800 美元)，儿科病房特别是新生儿病房额外费用可超过10 000美元。我国每年因发生医院感染而带来的直接经济损失也超过100亿元。吴安华[2]报道，国内医院感染可使每例患者的住院费用增加2 052~51 447.38元。医疗保险制度的改革，预示着可能会要医院自己承担由于医院感染所发生的额外费用。为评估医院感染造成的经济损失，采用1∶1配对病例对照研究方法，对某三级甲等医院外科系统2014年出院患者中因医院感染造成的直接经济损失进行回顾性调查分析，为控制和预防医院感染提供循证依据。……