Analysis of factors influencing the medical insurance balance of hospitalization expenses for gastric cancer surgery patients under DRG payment / 中华医院管理杂志

Objective:To analyze the influencing factors of the medical insurance balance of hospitalization expenses for gastric cancer surgery patients under DRG payment, for reference for promoting the reform of DRG payment in public hospitals and controlling hospitalization expenses reasonably.Methods:The gastric cancer patients enrolled in the gastroenterology department of a tertiary comprehensive hospital from January to July 2022 were selected as the research subjects. The indicators such as patient age, medical insurance balance, hospitalization expenses and their composition were extracted from the hospital information management system and the medical insurance settlement system a certain city. Descriptive analysis was conducted for all data, and stepwise multiple linear regression was used to analyze the influencing factors of patients′ medical insurance balance. Monte Carlo simulation method was used to simulate different combination scenarios of various influencing factors to analyze the probability of medical insurance balance.Results:A total of 205 patients were contained, including 117 in the medical insurance balance group and 88 in the loss group. The difference in hospitalization expenses and medical insurance balance between the two groups of patients were statistically significant ( P<0.05). The intervention of medical insurance specialists, correct DRG enrollment, parenteral nutrition preparation costs, anti infective drug costs, examination costs, and consumables costs were the influencing factors of patient medical insurance balance ( P<0.05). Through Monte Carlo simulation verification, patients with different cost parenteral nutrition preparations, or different anti infective drug schemes had the higher probability of medical insurance balance in the scenario where the medical insurance commissioner intervenes and the DRG enrollment was correct. Conclusions:The hospital adopted interventions from medical insurance specialists to ensure the correct DRG enrollment of patients, accurate use of parenteral nutrition and anti infective drugs, and reasonable control the cost of examinations and consumables, which could increase the probability of medical insurance balance for gastric cancer surgery patients. In the future, hospitals should further promote the procurement of drug consumables in bulk, reduce unnecessary examinations, develop standardized perioperative nutritional interventions and anti infection treatment pathways, ensure the accuracy of DRG enrollment, optimize clinical diagnosis and treatment pathways to improve the efficiency of medical insurance fund utilization and provide high-quality medical services for patients.

Relationship analysis between the supply structure of health resources with the growth structure of medical expenditure of Fuzhou / 中华医院管理杂志

Objective:To analyze the relationship between the structure of health resource supply and the growth structure of medical expenditure in Fuzhou.Methods:In accordance with hospital scale category standards, health resources provided for medium and large hospitals were categorized as high quality resources, while those provided for urban community health centers and township hospitals, and those for hospitals with less than 200 beds were categorized as primary health resources. The descriptive statistical method was used to analyze the health resource allocation and supply in Fuzhou; The structure decomposition method was used to decompose 2016—2019 hospitalization expenditure, and the principal component analysis was used to discuss the influencing factors of differences in the growth structure of hospitalization expenses.Results:In accordance with such factors as the economic development level, health service needs and geographical locations of districts and counties of Fuzhou city, 12 districts/counties were divided into three levels. The number of high-quality health resource medical institutions deployed in the first and second-level regions accounted for 78.95% of all. Among them, GL and TJ districts were equipped with hospital beds accounting for 44.29% of the total high-quality beds of all, while those resources of third-level regions were mostly primary health resources.From 2016 to 2019, medical expenditure of public hospitals kept rising. As found in structural decomposition, scale effect was the fundamental driver, followed by the structural effect, and then the inflation effect. This study identified increased inpatient service demand as the main driver for increased costs. Principal component regression results found that increased supply of high quality health resources as having a positive pull effect on the increase of hospitalization expenditure.For example, expansion of hospital beds at large hospitals contributes positive effect on the cost inflation( β1=0.421, P<0.001). On the other hand, investment in primary health resources could play a constraint role on excessive growth of medical expenditure, while the overall deployment level of their health resources affected negatively the patient flow(beds/per thousand population β2=-0.303, P<0.001). Conclusions:The structure of health resource supply is strongly related to the structure of medical expenditure growth. It is suggested to differentiate the allocation of high-quality and basic-quality health resources and optimize the supply structure of resources. It is also imperative to strengthen the investment in basic health resources and enhance the medical and health service capabilities of related institutions, in order to optimize the flow of residents′ medical visit flow and guide medical expenditure growth in a reasonable manner.

Trend in medical expenditures for patients with kidney diseases: An analysis from a tertiary hospital in Beijing / 北京大学学报(医学版)

OBJECTIVE@#To investigate trends in hospitalization expenditures in adults with kidney disease, to analyze the time pattern of outpatient and inpatient medical expenditures for patients with kidney diseases, and to support the health care reform by exploring the causes.@*METHODS@#Medical expenditure data for kidney disease patients aged ≥18 years from the outpatient and in-patient data of the information center in the Grade?A tertiary hospital in Beijing, China from January 1, 2012, to December 31, 2017, were retrospectively analyzed. It provided descriptive evidence on the time patterns of expenditures per visit and capita, and potential influencing factors of the time changes were further explored.@*RESULTS@#It was found that medical expenditures had increased rapidly from 2012 to 2017. The result showed that the average outpatient expenditure per capita for kidney disease patients was 4 598 yuan in 2012, with an increasing tendency to 11 536 yuan in 2017. There was an obvious increase in the average number of visits (per year) from 3.94 in 2012 to 9.11 in 2017. Meanwhile, the mean inpatient expenditures per capita had an increasing tendency from 323 753 yuan in 2012 to 45 904 yuan in 2017. There was also an increase of mean inpatient expenditures per admission from 27 184 yuan in 2012 to 34 933 yuan in 2017, with a similar number of admissions over the 6 years. The increases in outpatient and inpatient expenditures per capita were driven by different reasons. The increase in outpatient expenditures per capita was driven by the increase of patient visits, while the increase in inpatient expenditures per capita was driven by the increase of the expenditures per admission. Also, drug and medical materials were the two categories that had the largest contribution to the inpatient expenditures. Drug expenses were the highest one, with an average of 12 524 yuan per visit in 2017, accounting for 32.4% of the average total expenditure in that year, while the average cost of consumables was 9 215 yuan, accounting for 23.9%.@*CONCLUSION@#The increase of outpatient expenditures per capita was related to the increase of patient visits. Meanwhile, the growth of drug and consumable costs contributed to the total increase in the total inpatient healthcare costs. It is necessary to increase the proportion of treatment costs and medical service fees in the total expenditure.

Descriptive analysis of prevalence and medical expenses of cancer, cardio-cerebrovascular disease, psychiatric disease, and musculoskeletal disease in Korean firefighters

Relationships between stress hyperglycemia and illness severity as well as medical expenditure in emergency patients / 中华内分泌代谢杂志

Objective To study the relationships between stress hyperglycemia and illness severity and medical expenditure in emergency patients. Methods Totally 6128 consecutive hospitalized patients were enrolled from the emergency department. The clinical data of age, gender, stress hyperglycemia, hospitalization expenditure and rescue condition were compared according to diabetic history [ assigned to diabetes mellitus group ( DM) and non-diabetic mellitus group ( NDM ) ] and categories of the diagnosis. The data was compared by subgroups [ stress hyperglycemia group (SH) and control group (CON)]. Results DM patients had longer hospital stays, higher hospitalization expenditure and rescue rates (all P>0. 01) than NDM patients. In DM and NDM group, SH subgroup had higher inspection and medicine expenses, total costs and rescue rates than CON subgroup (all P>0. 05), and NDM+SH subgroup had the highest total costs and rescue rates. Logistic regression analysis showed that SH was an independentriskfactorforrescueinbothNDM[OR=3.817,95％CI(3.151-4.624)]andDM[OR=2.435,95％CI (1. 634-3. 631)] groups. In cardiovascular, respiratory, digestive, neurological, traumatic, and other disease layers, SH was also an independent risk factor for rescue (all P>0. 05). Multivariate regression analysis showed that SH was an independent determinant for total costs, inspection and medicine expenses and days of hospital stay (βwere7077.608,998.472,3495.271,and0.766respectively,allP>0.01). Amongcardiovascular,digestive,and neurological disease layers, SH was an independent factor responsible for days of hospital stay and total costs ( both P>0. 05). Conclusion In emergency admission patients, patients in SH subgroup were severer and had higher medical expenditure than those in CON subgroup. In stratified diseases layers, SH was an independent risk factor for rescuing and increased hospitalization expenditure. Patients in NDM+SH subgroup had more serious illness and more medical expenditure, compared with those in CON subgroup of NDM and DM group.

Effect of Work on Medical Expenditures by Elderly: Findings From the Korean Health Panel 2008–2013

BACKGROUND: This study was conducted to investigate the effects of work on medical expenditures by the elderly. METHODS: Data pertaining to individuals aged 65 or older collected by the Korean Health Panel 2008–2013 were used. The effects of work on medical expenditures were analyzed in a panel tobit model adjusted for several variables of demographic factors, socioeconomic factors, and health factors for health care. Data were also analyzed based on age groups (65–74, 75≤), type of work (waged or self-employed), and working time (daytime work or night time work). RESULTS: Among the elderly older than 65 years, 34–37% were workers. Work among the elderly reduced medical expenditures relative to nonworking elderly. Specifically, medical expenditures were lower in individuals older than 75 years, as well as among those who were self-employed insured and had medical aid insurance and those who exercised. However, medical expenditures were higher among females, married individuals, those with a higher household income, and those with a chronic disease. Elderly wageworkers showed reduced medical expenditures than nonworking elderly and elderly daytime workers did. CONCLUSION: The elderly population's work, especially wage work and daytime work, reduced medical expenditures relative to no work. These results provide valuable information for policymakers by indicating that work was associated with lower medical expenditures than no work. If elderly work is to be encouraged, it is necessary to provide a variety of high-quality wage work.

Analysis on the medical expenditure and influencing factors of the tumor and end-stage renal diseases of the poor patients in Hubei province / 中华医院管理杂志

Objective To analyze the basics and influencing factors for the medical expenditure of poor patients of tumor and end-stage renal diseases in Hubei province,and put forward policy recommendations for the critical illness insurance and health poverty alleviation.Methods 535 patients with tumor and end-stage renal diseases in Wuhan,Xiangyan and Shiyan in Hubei province were selected for a questionnaire survey,with 415 of the questionnaires subject to data analysis.Single factor variance analysis and multiple linear regression were used to analyze the influencing factors for their medical expenditure.Results 83.9% of the patients held their medical costs as too high;84.6% of them complaining significant drop of their annual family income due to their diseases; disposable household income of urban patients higher than their rural counterparts both before and after their disease; types of medical insurance and diseases are significant influencing factors for medical expenditure.Conclusions Poverty rate is high among patients of such patients.To reduce their financial burden,the government is recommended to cover more major diseases,enhance support for those of critical illness and improve the medical assistance system.

Analysis on the Characteristic of Annual Individual Medical Expenditure for Rural Residents / 中国卫生经济

Objective:To figure out the characteristics of annual medical expenditure for rural residents and its distribution among different population.Methods:The individual annual medical service utilization information was summarized after dealing with the database of the 2014 new rural cooperative medical system by Excel.It prescribed the clustering of medical expenditure by Lorenz curve and Gini index.Descriptive statistics and x2 test were used to compare the characteristics and distribution of the annual medical expenditure among rural residents.The Chi-square test was conducted to compare the differences of the population distribution.Results:The costliest 5％ patients accounted for approximately 68％ of total health care expenditure.The annual total expenditure was 16628 yuan per capita among high-cost population,while low-cost population were 108 yuan.The Gini index of medical expenditure for rural residents was 0.81.Among female and population over 45 years old,the proportion of high-cost population was higher than 5％.People living near provincial road,in flatlands or areas where the ability of township hospital was limited were nore likely to expense higher medical costs,known as 6.40％,5.50％ and 5.80％ separately.Conclusion:Clustering of medical expenditure for rural residents was remarkable,while the expenditure among high-cost,medium-cost and low-cost population were quite different.The elderly,female and primary population living in areas where the ability of township hospitals were limited were more likely to generate high medical costs.

Analysis of the medical expenditure beneficiary population in Liaoning province based on SHA2011 / 中华医院管理杂志

Objective To describe and analyze the distribution of medical expenditure of Liaoning province in 2014 in terms of population beneficiary based on the System of Health Accounts 2011(SHA 2011).Methods By means of multistage and stratified sampling, a total of 252 medical institutions were selected from four cities in Liaoning province according to their economic status and geographical distribution.Macro data including the outpatient income and hospitalization income were taken into account, to calculate the beneficiary population of the province in 2014 according to SHA2011.Results GBD classification found that the highest medical expenditure category was non-communicable diseases, accounting for 63.02% in total medical expenditure.ICD classification found that respiratory disease as consuming the highest medical expenses (43.76%).The average medical expenditure of the elderly population was the highest per person, up to 3 041.70 yuan per person.Conclusions Medical expenses of non-communicable diseases, respiratory disease and elderly population were still high.Thus we need to emphasize disease prevention, and take efficient measures against such key diseases to curb the medical expenses.The elderly population calls for specific and effective measures to reduce their medical expenses.

Analysis on medical expenditure of elderly population and health promotion strategies in Liaoning province / 中华医院管理杂志

High‐speed economic development and progress of medical technologies in China have significantly benefitted people′s health conditions.Significantly higher life expectancy in average ,as a result ,also contributed to population aging process.How to deal with the contradictions between population aging and rapid growth of medical costs is challenging the healthcare sector of the country.Analysis of medical costs at three tertiary hospitals in Liaoning Province discovered problems in out‐of‐pocket medical expenses of elderlies ,and proposed on measures to effectively ease their burden in medical expenditure .

Effects of catastrophic medical expenditure on rural poverty in China / 中国卫生政策研究

Helping all rural people living below the poverty line shake off is the most difficult task to build a moderately prosperous society in all respects. Based on 2014 China Household Panel Data Survey, this paper evalu-ates the effects of catastrophic health expenditure ( CHE ) on poverty in the rural areas of China by calculating the CHE and households poverty incidences, the poor families’ proportions, and the poverty incidence due to CHE and other indicators. According to estimated results, we recommend that CHE households should be regarded as the main target population to be shaken off poverty in the rural areas by the national health department. In order to maximize the poverty reduction performance, it is necessary to take into account both the poverty alleviation accuracy and cov-erage while setting the CHE criteria.

Impact of Selective Health Benefit on Medical Expenditure and Provider Behavior: Case of Gastric Cancer Surgery / 보건행정학회지

BACKGROUND: Selective health benefit was introduced for decreasing economic burden of patients. Medical devices with economic uncertainty have been covered as selective health benefit by National Health Insurance since December 2013. We aimed to analyze impact of selective health benefit to medical expenditure and provider behavior focused on electrosurgery Cultrasonic shears, electrothermal bipolar vessel sealers for gastric cancer patients covered since December 2014. METHODS: We used the National Health Insurance claims data of 2,698 patients underwent gastric cancer surgery between August 2014 and March 2015. Medical cost and patient sharing per inpatient day were analyzed to verify that covering electrosurgery increased medical expenditure and changed provider behavior from open surgery to endoscopic or laparoscopic surgery. Additionally, we analyzed the claim rate of medical device or goods relating gastric endoscopic and laparoscopic surgery. RESULTS: Medical cost and patient sharing per inpatient day were increased after covering electosurgery as selective health benefit (39,724/1,421 won). However, there were no medical expenditure increases after adjusting claim of electosurgery and patient sharing was decreased 1,057 won especially. The coverage of selective health benefit did not increase the claim rate of medical device or goods related endoscopic or laparoscopic surgery, either. CONCLUSION: Covering electosurgery decreased patient economic burden and did not change of provider behavior. Expanding selective health benefit is needed to decrease economic burden of severe patients. Further study should evaluate the long term effect with accumulated data.

Impact of itemized subsidies on medical expenditure burden in public hospitals:Analysis of da-ta on 23 medical institutions / 中国卫生政策研究

To a certain extent, itemized government subsidies to public hospitals, primarily used for hospital infra-structure and large equipment investments, can alleviate the financial pressure of development expenditures and thus re-duce the medical expenditure burden on patients. To test the hypothesis, the panel data method has been adopted based on the data of 23 tertiary hospitals. Empirical results find that:(1) increases in itemized subsidies will reduce the burden of medical expenses on patients;(2) conversely, the impact of itemized subsidies on outpatient medical expenses is more sig-nificant. By sharing a portion of public hospital expenses and impacting hospital service providing behavior, itemized sub-sidies help to reduce the burden of medical expenses on patients.

Correlation between quality and expenditure of medical care:a review of international studies / 中国卫生政策研究

The health care system has always faced challenges from two competing fronts: rising costs and quality concerns. The common issue of debate confronted by various health care systems is whether or not rising medi-cal expenditure can lead to quality improvements. The key to addressing this issue is to figure out the correlation be-tween quality of care and medical expenditure. Based on Donabedian’s structure, process and outcome quality theory, this study reviews relevant international studies related to this topic in order to provide empirical evidence in a clearer way. Results show that the analysis of current studies have typically been based on the regional level, health provider level and patient level; the quality indicators used varied among studies while expenditure indicators had much in common;more studies were found to focus on the association between outcome quality and expenditure while less studies explored the link between structure or process quality and expenditure; additionally, the majority of relevant studies were located in the inpatient setting and studies from outpatient settings were found to be lacking. Overall, ac-cording to current knowledge, no inclusive conclusion could be obtained, but quality indicators, data and methods, and limitations revealed in these studies can be reviewed by future study to explore the correlation between quality and expenditure of medical care in a more objective way.

The National Clinical Database as an Initiative for Quality Improvement in Japan

The JCVSD (Japan Cardiovascular Surgery Database) was organized in 2000 to improve the quality of cardiovascular surgery in Japan. Web-based data harvesting on adult cardiac surgery was started (Japan Adult Cardiovascular Surgery Database, JACVSD) in 2001, and on congenital heart surgery (Japan Congenital Cardiovascular Surgery Database, JCCVSD) in 2008. Both databases grew to become national databases by the end of 2013. This was influenced by the success of the Society for Thoracic Surgeons' National Database, which contains comparable input items. In 2011, the Japanese Board of Cardiovascular Surgery announced that the JACVSD and JCCVSD data are to be used for board certification, which improved the quality of the first paperless and web-based board certification review undertaken in 2013. These changes led to a further step. In 2011, the National Clinical Database (NCD) was organized to investigate the feasibility of clinical databases in other medical fields, especially surgery. In the NCD, the board certification system of the Japan Surgical Society, the basic association of surgery was set as the first level in the hierarchy of specialties, and nine associations and six board certification systems were set at the second level as subspecialties. The NCD grew rapidly, and now covers 95% of total surgical procedures. The participating associations will release or have released risk models, and studies that use 'big data' from these databases have been published. The national databases have contributed to evidence-based medicine, to the accountability of medical professionals, and to quality assessment and quality improvement of surgery in Japan.

Practice and exploration of average medical expenditure per visit control at the hospital / 中华医院管理杂志

A new round of public hospital reform demands higher requirement of public welfare and average medical expenditure control per visit.This paper introduced the practice of controlling the average medical expenditure per visit,and explored the control outcomes of the average medical expenditure per visit at the public hospitals.The measures proposed include supervision of key indexes,multi-angle control strategies formulation,multi-aspect effective pathway implementation,information feedback system improvement and high-cost medical consumables control.

A comparative study on medical expenditure for diabetes mellitus and non-diabetes mellitus in 9 provinces of China, between 2000 and 2009 / 中华流行病学杂志

Objective To compare the medical expenditure and its trend for diabetes mellitus and non-diabetes mellitus and to assess the direct economic burden of diabetes for individuals and families.Methods Using data from the China Health and Nutrition Survey (CHNS),propensity scores matching (PSM) was used to match diabetes mellitus and non-diabetes mellitus according to the related characteristic variables.Data from 679 pairs of objects was then compared.Results From 2000 to 2009,gaps of annual medical expenditure from diabetes mellitus and non-diabetes mellitus showed an increase,from 3361.93 to 6608.48 Yuan,with the ratios of medical expenditure about 4 times.The ratios of personal economic burden and family economic burden had an increase of about 4-5 times.Conclusion Compared with non-diabetes mellitus,the annual medical expenses was significantly higher among patients with diabetes mellitus.The absolute cost appeared a dramatic increase,along with the personal and familiar economic burden.

The Financial Mechanism of American Medicaid and the Medical Expenditure Expansion / 中国卫生经济

Objective: Analysis on the financial influences of for Medicaid expenditure expansion. Methods: Using Economics analysis to study the relation between the method of Federal Medicaid grants and scope of States Medicaid. Results and Conclusion:The design of transfer payment motivated the states government to pursue maximizing Federal grants , which led to the medical expenditure expansion. The Policy aims on establishing unify Medicaid policy in the nation and all grants raised from the Federal government.

Health expenditure analysis for urban and rural residents in China / 中华医院管理杂志

Objective To probe into the health expenditure and medical expenditure of Chinese people in rural and urban areas as objective references to improve the funding strategy of China's health care system. Methods Statistics annuals from 1999 to 2007 were called into play to analyze the status quo and trends of both expenditures. Results Definite proportion of funds raised for rural and urban health expenditure has grown by 200%;a distinct gap exists between the growth of per-capita medical expenditure in rural and urban residents (152. 86% in urban and 172. 77% in rural areas);medical expenditure maintains a steady growth along with rising per-capita income, yet the health consumption remains at a low level in general, especially among rural residents;since 2003, the income elasticity of the medical expenditure among rural residents keeps rising, narrowing the relative gap with urban residents. Conclusion It is recommended to push up the income of rural residents with greater resources, and to encourage the trend of marginal social medical expenditure. In addition, it is necessary to upgrade medical services, expand medical service coverage, and encourage reasonable consumption of medical services by both rural and urban residents;and to focus the role of cultural factors for greater awareness of the people in health investment and self-healthcare.

Medical Expenditure of National Health Insurance Attributable to Smoking among the Korean Population / 예방의학회지

OBJECTIVES: The purpose of this study was to determine the population-attributable risk (PAR) and estimate the total medical expenditure of the Korean National Health Insurance (KNHI) due to smoking. METHODS: We used data from the Korean Cancer Prevention Study of 1,178,138 Koreans aged 30 to 95. These data were available from 1992 to 2003 and covered a long-term follow-up period among the Korean population. RESULTS: The total medical expenditure of KNHI related to smoking increased by 27% from $324.9 million in 1999 to $413.7 million in 2003. By specific diseases, smokingattributable KNHI medical expenditure was the highest for lung cancer ($74.2 million), followed by stroke ($65.3 million), COPD ($50.1 million), CHD ($49 million) and stomach cancer ($30 million). A total of 1.3 million KNHI patients were suffering from smoking-related diseases in 2003. We predicted rises in total KNHI medical expenditure related to smoking to $675.1 million (63% increase compared with that of 2003) and in the total number of KNHI patients suffering from smoking-related diseases to about 2.6million (an approximate 100% increase compared with those in 2003) in 2015. CONCLUSIONS: We found a substantial economic burden related to the high smoking prevalence in South Korea.