ABSTRACT
Objective:To explore the influencing factors of hospitalization cost of acute myeloid leukemia, to group the cases based on decision tree model and to provide reference for improving the DRG management in this regard.Methods:Homepage data were retrieved from the medical records with acute myeloid leukemia as the main diagnosis (the top four ICD codes were C92.0, C92.4, C92.5, and C93.0). These patients were discharged from the clinical hematology department of the Fujian Institute of Hematology from January 2020 to December 2021. Then the influencing factors of hospitalization expenses were identified using Wilcoxon rank sum test or Kruskal-Wallis rank sum test and multiple linear stepwise regression analysis, with such factors used as classification nodes. The decision tree model of χ2 automatic interactive testing method was used to group the cases so included. At the same time, the included cases were grouped according to the trial run C-DRG version in Fujian province, for comparison of the differences between the two grouping methods. Results:The length of stay, the type of treatment, whether associated complications and age of patients were found as the influencing factors for the hospitalization costs of patients with acute myeloid leukemia, and such factors were included in the decision tree model to form 9 case mixes. The variance reduction of this model was 75.77%, featuring a high inter-group heterogeneity, and the coefficient of variation was 0.33-0.61, featuring a low in-group difference. The patients were divided into two groups according to the C-DRG version in Fujian province. The variance reduction of this method was 27.57%, featuring a low inter-group heterogeneity, and the coefficients of variation were 0.59 and 1.25, featuring high in-group difference.Conclusions:The cases of acute myeloid leukemia were grouped based on length of stay, type of treatment, whether accompanied by complications, and age proved reasonable enough to serve as reference for DRG management and cost control of this disease.
ABSTRACT
Objective:To seek any correlation between and prognosis and hospitalization costs of stroke survivors with dysphagia.Methods:The records of 1370 stroke survivors admitted to the rehabilitation departments of 3 public hospitals in Weifang were studied. Of them, 499 (36.4%) were diagnosed with dysphagia and 871 were not. Binary logistic regression and multiple linear regression were employed to analyze the correlation between dysphagia and the occurrence of pneumonia, modified Rankin Scale (mRS) scores, modified Barthel index (MBI) scores, length of stay and total hospitalization cost.Results:After adjusting for confounding factors, the risk of pneumonia in the dysphagia group was 2.4 times higher. At discharge, the risk of an mRS≥3 was 3.3 times greater and that of an MBI score <60 was 1.7 times greater with dysphagia. Multiple stepwise linear regression showed that dysphagia was significantly associated with higher mRS scores at discharge, lower MBI scores, and longer hospital stays. The standardized regression coefficients predict that after the length of stay, dysphagia is the strongest predictor of the cost of hospitalisation, followed by ADL ability, pneumonia, supratentorial, haemorrhagic stroke and CCI.Conclusions:Dysphagia is a significant predictor of the hospitalization costs of stroke patients. It is recommended to identify and treat dysphagia as early as possible to improve the prognosis of such patients and reduce the economic burden.
ABSTRACT
Objective To summary the hospitalization costs of lung cancer patients, and analyze the influence factors in these patients, and provide basis for controlling hospitalization costs of lung cancer patients. Methods The hospitalization costs data of hospitalized lung cancer cases in Wuhan from 2018 to 2020 were collected from medical records. Nonparametric test was used to analysis the data for single factor analysis. The patients were divided into two groups according on the upper quartile value of hospitalization cost, that is high-cost group (the cost ≥ the upper quartile value) and normal cost group (the cost “four major hospitals in Hubei” respectively. The hospital type is an independent influencing factors, compared with specialized hospital, the OR is 4.726 for general hospital. The hospitalization days is the independent influencing factors, more hospitalization days has high cost. The treatment mode is the independent influencing factors, compared with non-operative treatment, the OR is 556.129, 18.156 and 5.212 for surgical model, radio therapy model and interventional model respectively. Conclusion The age, hospital level, hospital type, hospitalization days and treatment mode are the independent influencing factors of hospitalization costs. To reduce the hospitalization cost of lung cancer patients, we should standardize the diagnosis of lung cancer patients, and focus on standardizing the treatment mode, also considering other influencing factors, such as hospital level, hospital type.
ABSTRACT
OBJECTIVE To analyze the grouping effect and composition of hospitalization costs for cases of patients with malignant proliferative disease under the diagnosis-related group （DRG） payment system， as well as any changes， in order to provide a basis for medical institutions to improve DRG payment-related measures， control drug costs， and for relevant departments to make decisions. METHODS The data of patients with malignant proliferative disease cases were collected from a “Third Grade Class A” hospital in 2021 and 2022， and the variation coefficient （CV） was used to evaluate the grouping of DRG. The structural variation degree and the new grey correlation analysis were used to study the structural variation of hospitalization cost and the correlation degree between the hospitalization cost and the cost of other items. RESULTS The overall reduction in variance （RIV） for the DRG group of patients with malignant proliferative disease was 79.36%； the CV of other groups were all lower than one except that the RW21 group was 1.09. Compared with 2021， the hospitalization cost for patients with malignant proliferative disease in 2022 decreased by 17.80%， and the decreases in management fees and drug costs were 32.15% and 21.30%， respectively， while the per capita medical expenses increased by 17.26%. The new grey correlation degree of drug cost decreased， but that of medical expenses increased. CONCLUSIONS Under the DRG payment system， hospitalization costs for patients with malignant proliferative disease in the sample hospital decrease， but the grouping efficiency of RW21 and other disease groups needs improvement， and the cost structure needs optimization.
ABSTRACT
BACKGROUND@#Out of pocket expenses still comprises a major share in health financing. A reactive approach in COVID-19 treatment may be problematic for the patient’s finances. National health insurance systems like PHIC have COVID-related care benefits, but whether these offer sufficient coverage is unknown.@*OBJECTIVES@#This study aims to describe the hospitalization costs incurred by pediatric COVID-19 patients admitted at a Filipino tertiary pediatric hospital, to determine the major cost drivers of hospitalization, and to determine how various payment methods provide coverage in paying for hospitalizations costs.@*METHODS@#Financial statements of pediatric COVID-19 patients were reviewed, from which costs were categorized. Deductions were also compared with total hospitalization to determine adequacy of various financial assistance programs.@*RESULTS@#Fifty-six charts and financial statements were reviewed for a 9-month period. Majority of the patients are of the 1-month to 6-year-old group (39.3%), of critical severity (66.1%), and with comorbidities (76.8%). Aggregated hospitalization costs of all COVID-19 patients amounted to PHP 9.5 million; medical costs accounted for the majority of the hospital costs at 35.40%. Mean total hospitalization cost per patient was determined to be PHP 170,170 and mean daily cost was PHP 16,870. PHIC COVID-19 packages may provide deducted as much as 90.56% of the overall costs, but only 28.6% of patients were able to avail of this privilege. Out-of-pocket expenditure remains at 33% of the total hospitalization cost.@*CONCLUSION@#COVID-19 hospitalization in this institution mainly consists of the 1-month to 6 years old, and the costs in the average can reach up approximately PHP 170,000, as basic medical fees drive the majority of the costs. Patients with no known comorbids tend to have higher costs of care but more data is needed to elaborate on the trend. Availing PHIC packages can greatly ameliorate the financial burden of hospitalization. However, checks in timely and accurate filing of claims should be in place to assure those that can avail this assistance are rightfully supported.@*RECOMMENDATIONS@#A larger patient base with equal representation of patient categories is recommended in order to determine more comprehensive cost patterns and make significant associations.
ABSTRACT
OBJECTIVES@#To understand the influence of medical insurance policy reforms in Guangxi on the hospitalization expenses of breast cancer patients by analyzing the composition and changing trend in breast cancer diagnosis and treatment expenses in the Guangxi Medical University Cancer Hospital, and to provide the evidence for the improvement of medical insurance policy reform.@*METHODS@#A total of 3 950 breast cancer patients were collected from 2014 to 2017 and analyzed. Kruskal-Wallis test and multiple linear regression model were used to discuss the breast cancer related epidemiology and analyze the composition of hospitalization expenses and its influential factors.@*RESULTS@#The median hospitalization cost of breast cancer patients in our hospital from 2014 to 2017 was 29 266.94 Chinese Yuan. Single factor analysis showed that the impact of year, hospitalization days, age, payment method, tumor stage, and treatment method on hospitalization cost was significant (all @*CONCLUSIONS@#Reasonably controlling hospitalization days and actively promoting the integration of urban and rural medical insurance can effectively reduce the economic burden for breast cancer patients.
Subject(s)
Female , Humans , Breast Neoplasms/therapy , Cancer Care Facilities , China/epidemiology , Health Expenditures , Hospitalization , Policy , UniversitiesABSTRACT
Since the performance appraisal of national tertiary public hospitals was carried out, higher requirements have been put forward for the operation and management of hospitals. Under the premise of ensuring the quality of medical service and medical safety, how to save hospital operating costs and improve the efficiency is an urgent problem for hospital managers. Supported by information upgrading, a tertiary hospital in Guangzhou reformed the treatment process and carried out pre-hospitalization in surgical departments. Data showed that pre-hospitalization can significantly shorten the length of stay, reduce hospitalization costs, and improve the operation efficiency of the hospital.
ABSTRACT
Objective:To investigate the dynamic change of nutritional risk in hepatological surgical patients during hospitalization.Methods:Anthropometric measurement and laboratory examination were conducted within 24 hours both after admission and before discharge. NRS 2002 was used to assess patients' nutritional status. The correlation between nutritional status and clinical outcomes was also analyzed.Results:A total of 600 patients were included in the study, among whom 401 were with benign diseases and 199 with malignant tumors. Compared with those values at admission, patients' weight, BMI, grip strength, calf circumference and main serum protein indicators decreased significantly at discharge ( P<0.05). The incidence of nutritional risk at discharge was 57.3%, higher than that at admission ( χ 2=6.512, P=0.011). The incidence of nutritional risk showed a significant increase during hospitalization in hepatological surgery patients ( P<0.05). Conclusions:Hepatological surgery patients were at high nutritional risk, which increased during hospitalization. The whole-course nutrition management of surgical patients should be given more attention.
ABSTRACT
Objective·To analyse the composition of hospitalization childbirth costs and its influencing factors, which provides theory basis on reasonable control of rapid growth of hospitalization childbirth costs. Methods·With the method of stratified random sampling, 12 secondary and tertiary hospitals were chosen in Shanghai. According to the hospitalization number, the maternal disease cases delivering from Jan. 1, 2016 to Jun. 30, 2016 were randomly selected. The basic information and the cost of hospitalization were collected, and the database was established. Descriptive statistics, z test, non-parametric test and multiple linear stepwise regression analysis were performed by SPSS 20.0. Results·The cost of hospital delivery per capita in Shanghai from Jan. to Jun. 2016 was 7 826.39 yuan, of which the cost of bed, inspection, operation and western medicine accounted for the highest proportion of the expenses (17%, 16%, 15% and 15%, respectively). Maternal hospitalization cost univariate analysis showed that the effect of age, occupation, payment, pregnancy complications, modes of delivery, length of stay, prenatal and postnatal pathological condition on hospitalization cost were statistically significant. A multifactorial study on the cost of hospitalization showed that the delivery mode, length of stay, prenatal and postnatal pathological pathological condition, age and pregnancy complications were the main influencing factors. Conclusion·The hospitalization cost of cesarean section is significantly higher than that of vaginal delivery, the hospital cost structure of these two modes of delivery is different, and the reduction of cesarean section rate is of great significance.It is necessary to optimize the hospital cost structure via controlling the cost of western medicine,operation, and inspection.
ABSTRACT
Objective: To analyse the composition of hospitalization childbirth costs and its influencing factors, which provides theory basis on reasonable control of rapid growth of hospitalization childbirth costs. Methods: With the method of stratified random sampling, 12 secondary and tertiary hospitals were chosen in Shanghai. According to the hospitalization number, the maternal disease cases delivering from Jan. 1, 2016 to Jun. 30, 2016 were randomly selected. The basic information and the cost of hospitalization were collected, and the database was established. Descriptive statistics, z test, non-parametric test and multiple linear stepwise regression analysis were performed by SPSS 20.0. Results: The cost of hospital delivery per capita in Shanghai from Jan. to Jun. 2016 was 7 826.39 yuan, of which the cost of bed, inspection, operation and western medicine accounted for the highest proportion of the expenses (17%, 16%, 15% and 15%, respectively). Maternal hospitalization cost univariate analysis showed that the effect of age, occupation, payment, pregnancy complications, modes of delivery, length of stay, prenatal and postnatal pathological condition on hospitalization cost were statistically significant. A multifactorial study on the cost of hospitalization showed that the delivery mode, length of stay, prenatal and postnatal pathological pathological condition, age and pregnancy complications were the main influencing factors. Conclusion: The hospitalization cost of cesarean section is significantly higher than that of vaginal delivery, the hospital cost structure of these two modes of delivery is different, and the reduction of cesarean section rate is of great significance. It is necessary to optimize the hospital cost structure via controlling the cost of western medicine, operation, and inspection.
ABSTRACT
Objective:To analyze the influential factors for inpatient care among residents in Shanghai and to provide evidence for health policy.Methods:Data were obtained from the Fifth National Health Services Survey,the independent variables were selected based on the framework of Andersen Model,and the two models were used to analyze the determinants-relevant hospitalization probability and the cost among residents in Shanghai.Results:The hospitalization rate among permanent residents over 18 years old was 6.1％ in 2013 in Shanghai.For the hospitalized population,its average expenses (median) were 10 000.00 yuan.Gender,age,education,marriage,smoking,drinking,exercise,the travel time,family annual income,Engel coefficient and the number of chronic diseases were the determinants of hospitalization probability.Gender,age,smoking,drinking,exercise,Engel coefficient,medicaid and level of medical institution were the influential factors for the hospitalization costs.Conclusion:The utilization of inpatient care among residents in Shanghai is determined by many factors.Thus,the corresponding health policies should be formulated for different populations.
ABSTRACT
Objective To analyze the blood glucose levels and related data of inpatients of different clinical departments, so as to provide a basis for normalized management of blood glucose in hospital. Methods Medical records of 1 726 discharged patients from 9 different clinical departments of Changhai Hospital in November 2014 were retrospectively analyzed using medical record inquiry system. The data included admission blood glucose, metabolic indexes, hospital stay and hospitalization expenses. The abnormal blood glucose and related factors were analyzed. Results We found that 99.19% (1 712) of the 1 726 inpatients had their blood glucose monitored once at least. According to their past medical history and blood glucose levels on admission or during hospitalization, 42.76% (738) patients had pathoglycemia. Endocrinology department (73.79%,76/103), geriatrics department (54.17%, 13/24) and pancreatic surgical department (50.54%, 93/184) had more pathoglycemia patients than other departments. The patients with newly discovered pathoglycemia (393) accounted for 22.77% of the inpatients, and the hospital stay and hospitalization expenses in these patients were significantly higher than patients with diabetes and impaired glucose regulation (IGR) and those with normal blood glucose (P<0.01). The levels of serum triglyceride (TG) and blood urea (BUN) of diabetic and IGR inpatients were significantly higher than patients with newly discovered high glucose and normal glucose (P<0.01); the levels of high density lipoprotein cholesterol (HDL-C) in diabetic and IGR inpatients and those with newly discovered pathoglycemia were significantly lower than that in those with normal blood glucose (P<0.01), but there was no significant difference between the former two groups. Conclusion Newly discovered hyperglycemia during hospitalization should not be overlooked. The blood glucose monitoring of high risk population should be reinforced on admission and during hospitalization, and a standard management of hyperglycemia should be established.
ABSTRACT
Objective:The paper is designed to reveal differences in stroke patients'hospitalization costs crea-ted by different socioeconomic factors , health insurance and occupational background , and analyze those differences on health outcome .Methods:18879 cases of hospitalized patients with stroke in five tertiary hospitals from four prov-inces from 2011 to 2014 were included in the database .Descriptive statistics was used to describe patients'hospitali-zation costs and health outcome .Multiple linear regression model and logistic regression were used to evaluate the im-pact of insurance and occupation .Results:After controlling for patients'social characteristics , health risks , premise during hospitalization process and clinical characteristics of patients with free healthcare costs , the socialized medi-cine was charged 19.7% higher than the private ones ( P <0.001 ), the retired people and civil servants were charged 4.2%(P<0.001) and 2.9%(P=0.049) more than farmers.The socialized medicine was also associated with health outcome.The risk of death in patients with free medical care is (OR=4.901) compared with private pa-tients (95%CI 1.652~14.537), and the retired people had increased risk of death compared with farmers (OR=2 .145 , 95%CI 1 .287 ~3 .573 ) .Conclusions: Due to the impact of social background factors , some groups are found to have a higher level of expenses than their counterparts during hospitalization , but the more hospitalization costs are not spent the better the health outcome of stroke was achieved .
ABSTRACT
Objective To set the cost standards for hospitalization based on the eases of the clinical pathway in order to help set a reasonable ceiling for the expenses of various diseases.Methods The multiple linear regression analysis was applied to find out influencing factors of hospitalization costs of the hysteromyoma.Diagnosis Related Groups(DRGs)ease mix was used to group 1777 hysteromyoma cases.Results The main factors for the expenses,as listed by their influence,were surgical operation or not,disease(s)of concomitance and the amount,adjusted R2 =0.6545.Hysteromyoma patients were divided into four diagnosis related groups; the all coefficient of variation(CV)is as small as 0.068,0.104,0.102,and 0.116 respectively.The hospitalization costs of the hysteromyoma of standard reference value were then calculated.Conclusion The standards interval for hospitalization costs set with DRGs case mix is reasonable and efficient,significantly useful for regulating medical practice and harnessing excessive costs of hospitalization.
ABSTRACT
Objective By investigating the influencing factors and the tendency of devel-opment of 6-year hospitalization costs in our hospital,our hospital explores an appropriate way of analysis on the influencing factors of medical costs,in order to offer some quantifiable evidence of evaluating and meaningful references to controlling medical costs. Methods to use the new method of gray correlation analysis to make the quantitative analysis of the composing of the hospital fees from 2002 to 2007.Results the new method of gray correlation analysis is able to overcome the influence of non-dimensional treatment which affects the role of factors and simplifies the calculation steps. Conclusion It is a statistical analysis method whose result is reasonable and reliable,whose application is flexible and simple. It can also offer a quantifiable index of the tendency of the system of development and changes. It is suitable for measuring the interrelated degree among the factors and the dynamic process of analysis.