吴琼　甘明玉　周良荣　湛欢

〔摘要〕 目的 分析2016-2018年湖南省冠心病患者住院費用结构变动情况，为有效控制住院费用的增长速度，实现医疗资源的优化配置提供依据。方法 采用多阶段分层抽样的方法，获取2016-2018年湖南省44家医疗卫生机构的25 430例冠心病患者住院数据。通过灰色关联分析法对各单项住院费用的关联程度进行分析;采用结构变动度分析法分析3年间住院费用结构变动情况，找出影响结构变动的主要项目。结果 2016-2018年药品费的关联系数和关联度最大，均为1.00，其次为治疗费、化验费和其他费用;3年间住院费用结构变动度为15.65%，治疗费、检查费、化验费、药品费是引起住院费用结构变动的主要因素，4项费用的累计贡献率为87.41%。结论 2016-2018年湖南省冠心病住院费用规模较大且呈上升趋势，今后需控制住院费用总量;药占比呈下降趋势，药品费呈上升趋势，需发挥中医药特色优势和作用;物化成本呈上升趋势，体现医务人员劳动价值的项目增幅不明显，需继续调整医疗服务价格。

〔关键词〕 冠心病;住院费用;灰色关联;结构变动

〔中图分类号〕C93       〔文献标志码〕A       〔文章编号〕doi：10.3969/j.issn.1674-070X.2021.01.028

〔Abstract〕 Objective To analyze the structure variation in coronary heart disease （CHD） patients in Hunan province from 2016 to 2018 and provide reference for controlling the growth rate of hospitalization expenses effectively and optimizing the distribution of medical resource. Methods Data of 25 430 patients with CHD from 44 medical institutions of Hunan province from 2016 to 2018 were collected by multistage stratified sampling. The gray correlation analysis method was used to analyze the degree of correlation among every item of hospitalization expenses. The degree of structure variation analysis method was used to analyze structure variation and find out the main items affecting the structure variation of hospitalization expenses for three years. Results From 2016 to 2018， the correlation coefficient and the degree of correlation of drug expense was the greatest with 1.00， followed by treat expense， test expense and other expense. The degree of structure variation of hospitalization expenses in 3 years was 15.65%. The main factors affecting structure variation of hospitalization expenses were treat expense， check expense， test expense and drug expense， which gave a cumulative contribution rate of 87.41%. Conclusion The scale of hospitalization expenses of CHD in Hunan province from 2016 to 2018 was large and showed an increasing trend， which suggested it's necessary to control the total amount of hospitalization expenses. The proportion of CHD medicine in Hunan province is on the decline， while the drug cost is on the rise， so we should play the characteristics and advantages of traditional Chinese medicine. The increase of items reflecting the labor value of medical staff was not obvious， and the materialization cost was on the rise.

〔Keywords〕 coronary heart disease; hospitalization expenses; gray relational analysis; degree of structure variation analysis

我国冠心病患者约1 100万[1]，由冠心病引起的猝死占80%左右[2]，冠心病早已成为严重影响中国城乡居民健康水平的公共卫生问题。冠心病是不可逆的慢性非传染性疾病，通常需要终身服药来维持心功能或采取手术扩张血管，其患者更有可能面临灾难性的个人卫生支出。冠心病住院费用的年均增长速度远高于国家GDP的增长速度[1]，给医疗保险统筹资金带来极大的压力，也给患者及家庭带来重大的疾病经济负担和无形精神负担。……