【摘要】 目的 通过灰色关联分析和结构变动度分析法，分析单病种患者住院费用占比及影响较大的费用构成项目。方法 研究资料来自河南省某三甲医院病案系统病案首页数据，选取2016-2022年一季度住院的急性心肌梗死患者为研究对象。通过灰色关联分析和结构变动度分析法，描述样本病种次均住院费用情况，对费用的构成以及近几年变动情况进行分析，找出患者住院费用内占比及影响较大的费用构成项目。结果 研究期间6 422例急性心肌梗死患者的次均住院费用为53 992.50元，次均费用呈先升后降的趋势，2019年达到高峰值。不同年份各项费用与次均住院费用的关联度及关联序列从大到小排列顺序依次为：材料费(0.815)、医疗服务费(0.795)、治疗费(0.772)、实验室诊断费(0.745)、药品费(0.733)、检查费(0.608)、其他费用(0.483)。2016-2022年一季度次均费用总体结构变动度为30.15%,年均结构变动度为5.03%。2020-2021年结构变动度最大，为15.08%,主要为材料费结构变动值较大。药品费结构变动值2017-2018年最大，为-4.19%。检查费、药品费、治疗费和材料费为次均住院费用结构变动贡献的主要项目，其中检查费次均费用结构变动最大，其累计贡献率高达44.11%,对住院次均费用结构变动贡献率较高。次均药品费累计贡献率38.09%,但医疗服务费对次均费用结构变动贡献率一直保持较低。结论 医疗服务价格改革对各项费用的影响明显，研究期间次均材料费的关联度最大，检查费用的结构贡献率最高。需继续深入推进公立医院综合改革，优化医疗服务价格体系，加强药品、高值耗材价格管理，体现医务人员技术价值。更多还原

【Abstract】 Objective To analyze the proportion of hospital expenses and identify the key cost components influencing hospitalization expenses of patients with a single disease using grey relational analysis and structural variability analysis.Methods The study data were sourced from the case data of a tertiary hospital’s medical record system in Henan Province.The subjects were patients with acute myocardial infarction who were hospitalized in the first quarter of each year from 2016 to 2022.Grey relational analysis and structural variability analysis were used to describe the average hospitalization expenses of the sample, analyze the composition of the costs and their changes in recent years, and identify the major cost components contributing to the hospitalization expenses.Results During the study period, 6,422 patients with acute myocardial infarction had an average hospitalization expenses of 53,992.50 yuan.The average cost exhibited an increasing trend followed by a decline, peaking in 2019.The correlation coefficients of various costs with the average hospitalization expenses in different years, ranked from highest to lowest, were as follows: material costs(0.815),medical service fees(0.795),treatment costs(0.772),laboratory diagnostic fees(0.745),drug costs(0.733),examination fees(0.608),and other expenses(0.483).The overall structural variability of the average hospitalization expenses from 2016 to the first quarter of 2022 was 30.15%,with an annual average structural variability of 5.03%.The structural variability peaked between 2020 and 2021 at 15.08%,primarily due to significant changes in material costs.The largest structural variability in drug costs occurred between 2017 and 2018,with a change value of-4.19%.The main contributors to the structural variability of the average hospitalization expenses were examination fees, drug costs, treatment fees, and material costs.Among them, examination fees had the largest structural variability, with a cumulative contribution rate of 44.11%.Drug costs contributed 38.09%,while medical service fees consistently had a low contribution rate to the structural variability of average hospitalization expenses.Conclusion The reform of medical service pricing has had a significant impact on various costs.Throughout the study period, the material costs showed the highest correlation with average hospitalization costs, and examination fees had the highest contribution to structural variability.Continued efforts are needed to advance the comprehensive reform of public hospitals, optimize the medical service pricing system, and strengthen the management of drug and high-value consumables prices to better reflect the technical value of healthcare personnel.更多还原