关键词: 结核,肺, 诊断相关患者组, 费用,医疗, 因素分析,统计学

Abstract:

Objective: To explore the composition characteristics and key influencing factors of hospitalization cost for pulmonary tuberculosis patients in Kunming under the Diagnosis-Related Group (DRG) payment model, so as to provide empirical evidence for improving local health economic policies related to tuberculosis prevention and control and optimizing the allocation of health resources. Methods: Medical records and DRG settlement data of 6878 inpatient admissions (2019) and 6851 inpatient admissions (2023) with a primary diagnosis of pulmonary tuberculosis in a Grade A tertiary hospital in Kunming were collected. After natural logarithmic transformation of total hospitalization cost, t-test and analysis of variance (ANOVA) were used for univariable analysis, and a multiple linear regression model was applied to screen the key influencing factors of total cost. Results: A comparison between 2019 and 2023 showed that total hospitalization cost for patients decreased from 86699500 yuan to 82742000 yuan, and per-episode costs fell from 12599.67 yuan to 12077.36 yuan. The proportion of diagnostic, therapeutic, and consumable costs rose from 41.37% (3586.40/8669.95), 13.12% (1137.85/8669.95), and 1.29% (111.94/8669.95) to 46.93% (3883.01/8274.20), 18.35% (1518.36/8274.20), and 1.85% (153.33/8274.20), respectively. Conversely, the proportion of general service and pharmaceutical costs decreased from 12.34% (1070.10/8669.95) and 31.86% (2762.44/8669.95) to 10.93% (904.63/8274.20) and 21.93% (1814.86/8274.20), respectively. Statistical analysis showed that in 2019, age (F=46.887, P<0.001), medical payment method (F=10.277, P<0.001), admission severity (F=113.119, P<0.001), and number of comorbidities (F=422.203, P<0.001) were all significant influencing factors of total hospitalization cost. In 2023, these factors remained significant, with the following values: age (F=38.116, P<0.001), medical payment method (F=2.637, P<0.05), admission severity (F=284.103, P<0.001), and number of comorbidities (F=114.027, P<0.001). Multiple linear regression revealed that length of hospital stay was the primary factor affecting total hospitalization cost (2019: β'=0.688, t=85.160, P<0.001; 2023: β'=0.592, t=61.760, P<0.001). Conclusion: The DRG payment model can effectively control hospitalization cost and optimize the cost structure for pulmonary tuberculosis patients in Kunming. Length of hospital stay is the primary factor influencing total hospitalization cost, while patient age, payment method, admission condition, and comorbidities also exert significant effects. In the future, DRG payment policies should be optimized in combination with these relevant influencing factors to improve the efficiency of health resource utilization.

Key words: Tuberculosis, pulmonary, Diagnosis-related groups, Medical expenses, Statistical factor analysis