Objectives: Stroke is the main cause of death in Chinese residents, bringing a heavy economic burden to patients. This study aims to explore the characteristics and the factors influencing the hospitalization cost for stroke, and to provide scientific evidence for reducing the economic burden on stroke patients.
Methods: The data were mainly obtained from the Shanghai Statistics Center for Health. Using the coding system of International Classification of Diseases (ICD)-10, we retrospectively collected the stroke-related first hospitalization records of stroke patients in J district, Shanghai during January 1, 2016 to December 31, 2019 whose main diagnostic disease codes were I61-I63. After cleaning and arranging the data, we counted the first hospitalization cost and length of hospital stay (LOS) of the patients. Univariate analysis was performed using non-parametric tests, and the factors influencing stroke hospitalization cost were further analyzed by multiple linear regression fitting path model.
Results: A total of 3 901 stroke patients were included. Ischemic and hemorrhagic stroke patients accounted for 92.59% and 7.41%, respectively, of which the mean hospitalization cost per patient were 12 397.35 yuan and 28 814.72 yuan, respectively, and the mean LOS per patient were 13 days and 19 days, respectively. Hospitalization cost for ischemic stroke mainly consisted of medicine fees, diagnosis fees, and service fees, accounting for 44.70%, 29.92%, and 15.42%, respectively, and hospitalization cost for hemorrhagic stroke mainly consisted of medicine fees, diagnosis fees, consumables fees, and service fees, accounting for 38.76%, 18.33%, 17.59%, and 15.38%, respectively. From 2016 to 2019, the proportion of medicine fees for ischemic stroke was decreased by 19.38 percentage points, and the diagnosis fees and service fees were increased by 8.43 percentage points and 9.04 percentage points, respectively; the proportions of medicine fees and consumables fees for hemorrhagic stroke were decreased by 7.54 percentage points and 13.43 percentage points, respectively, and the proportions of diagnostic fees and service fees were increased by 6.87 percentage points and 10.15 percentage points, respectively. Path analysis results showed that the main direct factors influencing hospitalization cost were the LOS, hospital level, operation, and year, and the main indirect factors were age and hospital level (all P<0.05).
Conclusions: The cost burden of stroke patients in Shanghai is relatively heavy, and we should continue to promote the medical reform policy and consolidate the achievements of medical reform. Hospitals should strengthen clinical pathway management and patient health education to improve medical efficiency and reduce invalid hospitalization days. Government departments should continue to improve the medical insurance system, enhance the supervision to medical insurance, and promote health equity.
目的: 脑卒中是中国居民死亡和寿命损失的主要原因，给患者带来了沉重的经济负担。本研究旨在了解脑卒中住院费用的特征及其影响因素，为减轻脑卒中患者的经济负担提供科学的指导依据。方法: 数据主要来自于上海市卫生健康统计中心。采用国际疾病分类(International Classification of Diseases，ICD)-10的编码系统，回顾性收集2016年1月1日至2019年12月31日上海市J区主诊断疾病编码为I61~I63的患者在全市的脑卒中相关首次住院记录。对数据进行清洗整理后统计患者的首次住院费用和住院天数，采用非参数检验进行单因素分析，进一步通过多元线性回归拟合通径模型，分析脑卒中患者住院费用的影响因素。结果: 共纳入3 901例脑卒中患者，缺血性和出血性脑卒中患者分别占92.59%和7.41%，例均住院费用分别为12 397.35元和28 814.72元，例均住院天数分别为13和19。缺血性脑卒中的住院费用主要由药费、诊断费和服务费构成，占比分别为44.70%、29.92%和15.42%，出血性脑卒中的住院费用主要由药费、诊断费、耗材费和服务费构成，占比分别为38.76%、18.33%、17.59%和15.38%。从2016到2019年，缺血性脑卒中药费占比下降19.38个百分点，诊断费和服务费分别上升8.43个百分点和9.04个百分点；出血性脑卒中药费占比和耗材费占比分别下降7.54个百分点和13.43个百分点，诊断费占比和服务费占比分别上升6.87个百分点和10.15个百分点。通径分析结果显示住院费用的主要直接影响因素为住院天数、医院级别、手术、年份，主要间接影响因素是年龄和医院级别(均P<0.05)。结论: 上海市脑卒中患者费用负担较重，应该继续推进医改政策，巩固医改成果。医院应该加强临床路径管理和患者健康教育，提高医疗效率，减少无效住院日。政府部门要继续完善医保制度，重视医保监管，促进健康公平。.
Keywords: factor; hospitalization cost; path analysis; stroke.