中文摘要：

目的 研究2009-2013年天津市参保慢性阻塞性肺疾病（chronic obstructive pulmonary disease,COPD）患者住院费用内部影响因素及发展趋势,为合理控制医疗费用、完善医疗改革提供参考。方法 采用新灰色关联法分析住院各项费用关联程度;运用结构变动值、结构变动度和结构变动贡献率等评价指标,分析5年间住院各项费用变化情况及其对总费用变化的影响程度。结果 5年间患者住院费用中,药品费关联度最大（1.0000）,其次是检查费（0.7232）、治疗费（0.6841）和医用材料费（0.6438）;药品费结构变动贡献率最大（36.78%）,占住院总费用比例下降,其次是检查费（32.48%）和医用材料费（8.61%）,占住院总费用比例上升,三者累计贡献率达77.87%。结论 控制药品费应作为减少COPD患者住院费用负担的关键突破口,加强高值医用材料监管,重视医护人员劳动价值,进而优化住院费用结构。

英文摘要：

Objective This study aimed to investigate the internal factors affecting hospitalization expenses and their tendency of development in patients with chronic obstructive pulmonary disease （COPD）in Tianjin from 2009 to 2013, in order to offer some meaningful references to control the medical expenses reasonably and improve the health care reform. Methods The new method of gray correlation was used to analyse the degree of correlation among every item of hospitalization expenses of patients. Value of structure variation（ VSV）, degree of structure variation（DSV） and the contribution rate of DSV were used to evaluate the change of every item of hospitalization expenses of patients and their influence on total expenses in 5 years. Results Among the hospitalization expenses in patients with COPD in 5 years, the medicine expense was most closely linked to the hospitalization expenses （ 1. 0000） followed by the examination （ 0. 7232 ）, treatment （0. 6841 ） and medical materials expense （ 0. 6438 ）. The medicine expense contributed mostly to the DSV（36. 78% ）, and there was a decrease on its proportion of hospitalization expenses. Then were the examination （32.48 % ） and medical materials expense （8.61% ）, and there were increases on their proportions of hospitalization expenses. The accumulated contribution rates of these three items were 77.87 %. Conclusion The control of medicine expense can be expected as a key breakthrough point to reduce the burden of hospitalization expenses in patients with COPD, then by strengthening the regulation of medical materials with high values and attaching a great importance to the labor value of medical staff, we can optimize the structure of hospitalization expenses.