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Objective@#To analyze the influencing factors for hospitalization costs among stroke patients with different subtypes, so as to provide the reference for reducing the economic burden of patients.@*Methods@#Data of patients with hemorrhagic or ischemic stroke who were discharged from hospitals in Nanshan District, Shenzhen City from January 1, 2016 to December 31, 2021 were collected through Hospital Information System. Hospitalization costs were analyzed between hemorrhagic and ischemic stroke patients, and factors affecting hospitalization costs among stroke patients with different subtypes were identified using a structural equation model.@*Results@#A total of 10 298 patients with stroke were recruited, including 2 820 patients with hemorrhagic stroke (27.38%) and 7 478 patients with ischemic stroke (72.62%). The patients with hemorrhagic stroke had a median duration of hospital stay of 19.00 (interquartile range, 18.00) d, and a median hospitalization cost of 26 759.48 (interquartile range, 51 000.87) Yuan. The patients with ischemic stroke had a median duration of hospital stay of 12.00 (interquartile range, 10.00) d, and a median hospitalization cost of 12 199.87 (interquartile range, 13 290.20) Yuan. Structural equation model analysis showed that department of hospitalization, discharge status, ways of leaving hospital, surgery and hypertension had direct effects on hospitalization costs and indirect effects on hospitalization costs through duration of hospital stay among hemorrhagic stroke patients, and duration of hospital stay had the highest total effect (0.684), followed by surgery (0.632). Employment status, admission route, department of hospitalization, ways of leaving hospital, payment mode, surgery and dyslipidemia had direct effects on hospitalization costs and indirect effects on hospitalization costs through duration of hospital stay among ischemic stroke patients, and duration of hospital stay (0.746), surgery (0.424) and department of hospitalization (0.151) ranked the top three in total effects.@*Conclusion@#The hospitalization cost is relatively high among stroke patients in Nanshan District, and duration of hospital stay and surgery have great influence on hospitalization costs among stroke patients with different subtypes.
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Objective:To study the composition and influencing factors of hospitalization expenses of patients with sequelae of ce-rebral infarction caused by the dominant diseases of traditional Chinese medicine(TCM),so as to provide references for the fine management within the hospital and the medical insurance department to improve the payment policy suitable for the characteristics of TCM.Method:A total of 1 261 cases with ICD code 169.3 in the sample of tertiary traditional Chinese medicine hospitals from 2020 to 2022 were collected.Single factor analysis,correlation analysis,multiple linear stepwise regression and other methods were used to analyze the composition and main influencing factors of hospitalization expenses of patients with cerebral infarction sequelae.Re-sults:The average length of hospital stay of patients with sequelae of cerebral infarction was 16.71 days per time,the average hospi-talization cost was 24 148.83 yuan per time,and the proportion of TCM treatment cost per time was 54.43％.The results of stepwise regression showed that the length of stay,the condition of admission and the complication of pulmonary infection had a significant im-pact on the hospitalization expenses(P＜0.05),and the length of stay had the greatest impact.Conclusion:It is suggested that the hospital should optimize and improve the clinical pathway of TCM dominant diseases and establish an effective dynamic management mechanism,and the medical insurance department should improve the adjustment mechanism of the auxiliary list of TCM dominant diseases under the disease scoring payment.
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Objective@#To examine the effect of diagnosis-related groups (DRGs) point payment on hospitalization costs of parturition among lying-in women, so as to provide the evidence for alleviating the burdens and saving medical resources among lying-in women.@*Methods@#Lying-in women's age, gestational age, parity, duration of hospital stay, DRGs grouping and hospitalization costs were collected from the Inpatient Medical Record System and DRG Operation Analysis System in a tertiary women and children's hospital in Ningbo City from 2020 to 2021. The changes of hospitalization costs of parturition were compared among lying-in women before and after DRGs point payments, and the association between DRGs point payments and gross hospitalization costs of parturition was examined among lying-in women using a multivariable logistic regression analysis.@*Results@# A total of 11 505 lying-in women after DRGs point payments, including 6 216 women at age of 30 years and below (54.03%), and 10 871 lying-in women before DRGs point payments, including 6 208 women at age of 30 years and below (57.11%), were enrolled. The median (interquartile range) gross hospitalization expenses, material expenses and laboratory testing expenses of parturition were 8 519.19 (2 456.61), 881.38 (816.16) and 939.00 (310.00) Yuan among lying-in women after DRGs point payments, which were significantly lower than those [9 123.13 (2 660.33), 915.57 (825.26), 1 036.00 (385.00) Yuan] among lying-in women before DRGs point payments (Z=-21.971,-16.061 and -27.199, all P<0.001). Multivariable logistic regression analysis showed that DRGs point payment was statistically associated with lower gross hospitalization expenses of parturition among lying-in women after adjustment for age, duration of hospital stay, gestational age, parity, type of delivery and development of complications (OR=0.462, 95%CI: 0.432-0.494).@*Conclusion@#DRGs point payment is beneficial to reduce the hospitalization cost of parturition among lying-in women.
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OBJECTIVE To explore the grouping efficacy of diagnosis related group （DRG） and the influential factors of hospitalization cost in diabetes cases， and to provide theoretical support for improving DRG payment system， reducing medical cost and enhancing the efficiency of medical insurance funds. METHODS The information of 4 368 diabetic patients who were hospitalized in a 3A hospital in Xi’an from January 1， 2021 to June 30， 2023 was retrospectively analyzed， and DRG grouping of them was summarized； the hospitalization costs of patients in different DRG groups were analyzed by using one way ANOVA and Bonferroni multiple comparison. Coefficient of variation （CV） was used for evaluation within the group， and the influential factors of hospitalization costs were analyzed by one-way linear regression analysis and multi-factor linear regression analysis. RESULTS & CONCLUSIONS The CV values of the four DRG groups were all lower than 0.8， indicating good grouping results and good consistency within the group； the difference of hospitalization cost among the four groups was statistically significant （P＜0.05）， and the hospitalization cost of China Healthcare Security-DRG version 1.1 FW11 group was significantly higher than those of other three groups （P＜0.05）. Length of stay， drug cost， the number of other diagnoses， test cost and payment method have significant positive effects on the hospitalization cost of diabetic patients. Whether there is pharmacist intervention has a significant negative influence on the hospitalization cost of patients. Under the DRG payment method， medical institutions can consider multidisciplinary linkage and incorporate a variety of management and service tools， including pharmacist’s intervention， to develop refined management measures， to reduce the economic burden of patients’ families and society.
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Objective:To analyze the adjustment of the amount of medical insurance reimbursement with the addition of the age factor, making the system more in line with the actual clinical resource consumption.Methods:Data were collected from the first page of medical records of 54 535 inpatients discharged from hospital between January 1 th, 2021 and December 31 th, 2021.First, the paired t-test was used to verify any statistical difference between the standard payment amounts before and after adjustment based on the model and the actual hospitalization expenses.Secondly, the actual cost was compared with the cost after the model-based adjustment and the current benchmark cost(before adjustment), respectively.The standard deviations of the two groups were compared to assess the difference between the benchmark cost and the actual cost before and after adjustment. Results:Through the Blom formula, the actual cost, adjusted benchmark cost and current benchmark cost data were normalized.After normalization, the actual expenses and the adjusted benchmark cost as well as the actual expenses and the current benchmark cost were compared, respectively, using the paired t-test, producing a P value of 0.97 for the former pair and a P value of 0.93 for the latter pair, both greater than 0.05, and the benchmark cost before and after adjustment could reflect the actual clinical resource consumption.However, the effect of benchmark cost adjustment was assessed by analyzing the standard deviation of the difference between paired values of the two groups.The standard deviation of paired values between the actual expense and the adjusted benchmark cost was 0.68, lower than the standard deviation of paired values between the actual expense and current benchmark cost, which was 0.7. Conclusions:With the inclusion of the age factor, the model can reasonably adjust the current benchmark cost based on the patient's age and verify that the adjusted benchmark cost can more accurately reflect the actual clinical resource consumption compared with the current standard.However, further improvement of the payment adjustment model is still needed.
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OBJECTIVES@#To determine the cost of hospitalization, percentage distribution of expenses, and average expenditures covered by PhilHealth, hospital share and patient’s share in financing the hospitalization of pediatric focal epilepsy patients in a tertiary government hospital.@*METHODOLOGY@#This is descriptive retrospective research of patients diagnosed and managed as focal epilepsy from July to December 2018. Mean, standard deviation and percentage distribution of expenses were determined.@*RESULTS@#The mean cost of hospitalization is 21,545.96 Php and the laboratory cost contributes the most to the total cost with a mean of 6,046.08 Php. The mean cost shouldered by PhilHealth is 3,734.26 Php which is 17.33% of the total cost of hospitalization.@*CONCLUSION@#The laboratory cost makes up most of the hospital cost. Philhealth covers a small percentage of the hospitalization cost of pediatric focal epilepsy patients with most of the total cost shortly followed by the patient’s share.
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Objective: To compare the cost changes of total knee arthroplasty (TKA) before and after the cancellation of medical consumables addition, so as to provide reference for the national medical reform policy. Methods: The patients treated with TKA between September 2018 and February 2019 were admitted as objects of study, and 372 of them met the selection criteria and were finally included in the study. According to the time node of cancelling the medical consumables addition (December 24, 2018), all patients were allocated to pre-cancelling and post-cancelling groups ( n=186). The clinical data of patients (gender, age, length of stay, disease classification), and various treatment costs (the costs of diagnosis and treatment, examination, laboratory, material, anesthesia, bed, nursing, operation, drug, and others) were collected. And the changes of various costs and proportions before and after cancelling the medical consumables addition were compared. Results: There was no significant difference in gender, age, and disease classification between the two groups ( P>0.05); the length of stay after cancelling the medical consumables addition was significantly longer than that before cancelling ( t=2.114, P=0.035). There was no significant difference in the total cost of TKA before and after cancelling the medical consumables addition ( t=0.214, P=0.831). Compared with that before cancelling the medical consumables addition, the cost of material was significantly reduced, and the costs of diagnosis and treatment, anesthesia, nursing, and operation were significantly increased ( P0.05). Conclusion: The total cost of TKA is stable, the proportion of material cost is significantly reduced, the proportion of diagnosis and treatment cost reflecting the technical content of medical staff is significantly increased, which is in line with the expectation of the national policy of cancelling the medical consumables addition.
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Objective@#To analyze the influencing factors of hospitalization cost by back propagation(BP)neural network.@*Methods@#Inpatients with a total of 50 611 were collected from the hospital information system in a tertiary hospital. BP Neural network modeling was developed by SPSS 22.0 software to study the factors which influence the hospitalization cost.@*Results@#The hospitalization expenses prediction accuracies of training sample and test sample were 81.1% and 79.0% respectively. The top three factors were pharmaceutical cost(100.0%), general medical operation cost(88.8%)and disposable medical materials cost(60.7%).@*Conclusions@#The results show that BP model is suitable for dependent variable with the hospitalization expenses. The pharmaceutical cost, disposable medical materials cost and general medical operation cost were greater influencing factors than others. We should take actions by improving the treatment level and measures, so as to reduce the economic burden of patients and society
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Objective To analyze the direct economic burden and average hospitalization cost of lung cancer in China from 2011 to 2015, to provide data support for the prevention and control of lung cancer and health insurance policies. Methods By using inpatient medical record home page dataset to estimate the total hospital expenses of lung cancer. Using the outpatient hospitalization cost ratio of cancer specialized hospitals to estimate the overall medical expenses of lung cancer. Based on the inpatient medical record home page dataset, and analyzed the average hospitalization cost of lung cancer. Results The total cost of lung cancer in China reached 24.31 billion yuan in 2015, accounting for about 0.6％ of the total health expenses; from 2011 to 2015, lung cancer medical costs have concentrated in the grade 3 general hospitals; people over 60 consumed the major medical costs of lung cancer and the proportion was still rising year by year; the average hospitalization cost of lung cancer was reduced in 2015; drug proportion in various hospitals declined steadily from 2011 to 2015; the average hospitalization cost was the highest in the 18 -40 age group. Conclusion The effect of health care reform was gradually revealed, and the increase of medical expenses was controlled within the tolerable range. Notably, we should accelerate the improvement of the price compensation mechanism, and at the same time, we should aim to improve the level of catastrophic health care for the elderly.
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Objective:To explore the influential factors for hospitalization costs regarding the final phase of malignant tumor patients in Shanghai,and to explore the relevant policy for reasonable control of hospitalization costs.Methods:A total of 10 065 patients with malignant tumors were enrolled in this study.The multiple linear regression analysis was used to seek the determinants for hospitalization cost of malignant tumor patients during the final phase.Results:The median length of hospital stay was 43 days for the patients,with an average age of (70.73±12.87) years.Among them 61.66％ of hospitalized patients were male and the median hospitalization cost of malignancy was 55 447.84 yuan.Hospitalization cost showed the linear regression relationship with type of health care,hospital level,hospital types,tumor types,length of hospital stay,surgery,age,gender,and time from hospital admission to death.Conclusion:Proximity to death in malignant tumor patients is an important factor for the hospitalization cost.Medical resources should be allocated rationally,and the comprehensive measures should be taken to control the cost reasonably.
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Objective To explore the variation tendency and influencing factors of the hospitalization costs and hospital day of soldiers in a navy hospital, so as to provide reference for the health resource allocation of military hospitals. Methods The data of 16 278 military patients who were hospitalized and treated from Jan. 2008 to Dec. 2016 were extracted from the military health system. The hospitalization costs and status, variation tendency and influencing factors of hospital slay were analyzed by descriptive analysis, Mann-Whitney U test and Kruskal Wallis H test. Results The average age of admission was (28. 33+13. 40) years, and the hospitalization period showed a shortening trend, while the hospitalization costs showed an increasing trend during 2008-2016. The polytomous variables, including services, patient s condition, hospitalized limes, hepatitis B surface antigen, hepatitis C antibody, human immunodeficiency virus (HIV) antibody, military appointment, age and outcomes, and the dichotomous variables, including severe condition, critical condition, ICU admission, special-grade nursing care, first-grade nursing care, allergies and operation, were the influencing factors of hospitalization expenses (P
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@#Objective To explore the variation tendency and influencing factors of the hospitalization costs and hospital day of soldiers in a navy hospital,so as to provide reference for the health resource allocation of military hospitals.Methods The data of 16 278 military patients who were hospitalized and treated from Jan.2008 to Dec.2016 were extracted from the military health system.The hospitalization costs and status,variation tendency and influencing factors of hospital stay were analyzed by descriptive analysis,Mann-Whitney U test and Kruskal-Wallis H test.Results The average age of admission was (28.33± 13.40) years,and the hospitalization period showed a shortening trend,while the hospitalization costs showed an increasing trend during 2008-2016.The polytomous variables,including services,patient's condition,hospitalized times,hepatitis B surface antigen,hepatitis C antibody,human immunodeficiency virus (HIV) antibody,military appointment,age and outcomes,and the dichotomous variables,including severe condition,critical condition,ICU admission,special-grade nursing care,first-grade nursing care,allergies and operation,were the influencing factors of hospitalization expenses (P＜0.05).The polytomous variables,including services,patient's condition,hospitalized times,HIV antibody,military appointment,age and outcomes,and the dichotomous variables,including gender,severe condition,critical condition,special-grade nursing care,first-grade nursing care and operation,were the influencing factors of hospitalization stay (P＜0.05).Conclusion The decreasing hospitalization day of military patients and increasing hospitalization costs suggest that the medical technology and hospital management efficiency are continuously improving,but facing the pressure of increasing medical costs.From a cost-effective perspective,we should strengthen the graded referral and control hospitalization costs and length of hospital stay.
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Objective To compare whether there is a difference in medical cost of intensive care unit(ICU)pa-tients with catheter-associated infection (CAI)between before and after targeted intervention.Methods CAI in ICU patients in 2010(pre-intervention group)and 2013 (post-intervention group)were investigated by retrospective survey,hospitalization cost of two groups of patients before and after intervention was compared.Results The morbidity and mortality in patients with CAI both decreased significantly after intervention,morbidity of healthcare-associated infection(HAI)decreased from 13.47% in 2010 to 4.41 % in 2013,mortality decreased from 10.36% in 2010 to 2.2% in 2103.Total hospitalization cost,blood transfusion cost,and cost of special material before and af-ter the implementation of targeted intervention all significantly different (all P <0.05),the difference of procalcito-nin and antimicrobial agents cost were also significant(all P <0.05).Conclusion Medical cost in ICU patients with CAI decreased after intervention.
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Objective To investigate the hospitalization cost,length of stay in hospital,and mortality in patients with pulmonary infection in a hospital,and evaluate the influencing factors,so as to provide scientific basis for mak-ing targeted infection control measures.Methods Medical records of patients with pulmonary infection between January 2011 and December 2012 were collected,the difference and influencing factors of hospitalization cost,aver-age length of stay,and prognosis among patients with different types of pulmonary infection were compared and an-alyzed by univariate analysis,multiple linear regression analysis,and logistic regression analysis.Results Of 10 431 patients with pulmonary infection,the average hospitalization cost was (29 081 .95 ± 38 682.92 )yuan (RMB),the median cost was 16 085.25 yuan(RMB),and the average length of stay was (15.93 ±20.54)d,the median was 13.00 d,a total of 828 patients died due to invalid treatment,mortality was 7.94%.There were signifi-cant differences in hospitalization cost,average length of stay among patients with different genders,ages,modes of payment,admission status of illness,types of pulmonary infection,and operation or not (all P <0.05),and the differences in mortality were also significant among patients of above characteristics except gender(all P <0.05 ). Influencing factors for hospitalization cost were as follows:length of stay,whether or not operated,modes of pay-ment,types of pulmonary infection(healthcare-associated pneumonia,HAP),age,gender,and so on,influencing factors for length of stay were whether or not operated and types of pulmonary infection,factors leading to death were admission condition, types of pulmonary infection (HAP ),and whether or not operated, and so on. Conclusion Control of healthcare-associated pulmonary infection is important for controlling hospitalization cost, shortening average length of stay,and improving survival rate of patients.
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Objective: To analyze the structure changes of New Rural Cooperative Medical System(NCMS) patients ’ hospitalization costs in a county-level city, and provide references for controlling hospitalization cost. Methods: Collect the cost details of NCMS patients in May from 2012 to 2013, and analyze the structure changes of hospitalization costs though the analysis method of structure variation degree. Results: Specialized hospital has the largest structure change of hospitalization cost, followed by first-level hospitals. Different cost items at hospital of different levels have a different direction of structure changes. Drug and examination are the major factors posing the changes in structure of hospitalization costs. Conclusion: There are significant results on the cost control since the implementation of new NCMS. Although the role of Chinese medicine to be prominent, there is still insufficient. The control of examination cost is a link which could not be ignored in future.
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Objective: Through comparing the hospitalization costs of total knee replacement (TKR) in People’s Hospital of Peking University in 2005 and 2010, to investigate the changing status of hospitalization costs on this operation and the impact of clinical pathway ( CP ) on controlling the hospitalization costs during 5 years , and provide references for controlling medical treatment cost reasonably. Methods: The patients are grouped into undergoing unilateral and bilateral TKR. The total hospitalization cost and cost of each category during 5 years are compared, and SAS 9.2 statistic software is applied to deal the data. Results: Compared with 2005, the total cost for TKR in 2010 decreased. All the charging items decreased, except implant material increased, especially the cost of surgery, hospital room, nursing and pharmacy. Specific to one knee replacement group and both knees replacement, the changing trend of cost is coincident with the total cost. Conclusion: The total cost for TKR in 2010 was lower than that of 2005, which might be the result of adopting CP since 2010. Nevertheless, the implant material cost accounted large proportion of hospitalization cost in 2010, and it has obvious increasing trend compared to 2005. This result is related the increasing application of the new edition of Artificial knee joint prosthesis. Controlling implant material cost is the effective method of decreasing medical costs for TKR.
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This article reviews the neonatal birth rate, premature birth rate, premature survival rate and the neonatal treatment costs in Korea. The neonatal birth rate has decreased steadily during past 40 years, which is a serious social problem. However, the premature birth rate has increased by about 8~9 % because most complicated pregnancies were early delivered and the social environment has changed. The survival rate of the preterm has increased remarkably due to improvements in neonatology in Korea from 40% in 1980, to 71% in 1990, and to 78% in 2000. The newest report in 2007 for survival rates of the preterm was 95.3% for low birth weight infants, 84.7% for very low birth weight infants and 67.7% for extremely low birth weight infants. The average total hospitalization cost per person who were admitted in the neonatal intensive care unit was 4,360,000 won. The portion of the hospitalization cost covered by the National health insurance was 77.1% and 22.9% of the total hospitalization cost was not covered by the National health insurance. The hospitalization cost increased as the birth weight decreased and as the hospitalization period increased.