摘要
目的 分析针灸治疗周围性面瘫患者直接经济负担及其影响因素,为针灸治疗周围性面瘫费用提供科学的指导依据.方法 周围性面瘫患者资料收集自湖南省卫生健康统计中心.采用国际疾病分类的编码系统,回顾性收集2019年1月至2022年12月湖南省三级甲等中医医院管理信息系统中门诊周围性面瘫患者.对数据进行整理后统计针灸治疗周围性面瘫患者的治疗次数和门诊费用,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,分析周围性面瘫患者门诊费用的影响因素.结果 共纳入1 766例周围性面瘫患者,周围性面瘫患者直接经济负担人均7 035.58元,治疗次数人均14.43次,周围性面瘫门诊费用主要由针灸治疗费、综合医疗服务费、诊断费、药费、推拿治疗费及耗材费构成,占比分别为36.18％、18.83％、15.50％、23.97％、3.79％和1.73％.从2019年到2022年,针灸治疗周围性面瘫患者针灸治疗费和综合医疗服务费分别提高14.37％和4.49％,西药费、中草药费、中成药费、耗材费占比分别下降12.63％、0.41％、5.24％、0.9％.通径分析结果显示,治疗费用的主要直接影响因素为治疗次数、年龄、医保类型.结论 针灸治疗周围性面瘫应突出针灸临床路径优势,扩大针灸优势病种进入按病种付费,增加针灸医师的福利,重视医保监督,促进健康公平.
Abstract
Objective To analyze the direct economic burden of acupuncture and moxibustion treatment for patients with peripheral facial paralysis(PFP)and its influencing factors,and to provide scientific guidance for the cost of acupuncture and moxibustion treatment for PFP.Methods Data of PFP patients were collected from Hunan Provincial Health Statistics Center.The coding system of International Classification of Diseases was used,and PFP outpatients were retrospectively collected from the management information system of tertiary A-level hospitals of Chinese medicine in Hunan Province from January 2019 to December 2022.After cleaning and sorting out the data,the number of treatments and outpatient expenses for PFP patients treated with acupuncture and moxibustion were counted.Nonparametric test was used for univariate analysis,and then the path model was fitted by multiple linear regression to analyze the influencing factors of outpatient expenses of PFP patients.Results A total of 1,766 PFP patients were included.The direct economic burden per capita on PFP patients was 7,035.58 yuan,with an average of 14.43 treatment sessions per person.The outpatient expenses for PFP were mainly composed of acupuncture and moxibustion treatment fees,comprehensive medical service fees,diagnosis fees,medicine fees,tuina treatment fees,and consumable fees,accounting for 36.18％,18.83％,15.50％,23.97％,3.79％,and 1.73％,respectively.From 2019 to 2022,the acupuncture and moxibustion treatment fees and comprehensive medical service fees for PFP patients increased by 14.37％and 4.49％,respectively,while the proportions of Western medicine fees,Chinese herbal medicine fees,Chinese patent medicine fees,and consumable fees decreased by 12.63％,0.41％,5.24％,and 0.9％,respectively.The path analysis showed that the main direct influencing factors of treatment costs were the number of treatments,age,and type of medical insurance.Conclusion The advantages of clinical pathways for acupuncture and moxibustion should be highlighted during the PFP treatment with them,and the inclusion of acupuncture-advantaged diseases into diagnosis-related group(DRG)payments should be expanded.The benefits for acupuncture practitioners should be enhanced.Emphasis should be put on medical insurance supervision so as to promote health equity.
维普
万方数据