Health benefit utilization and out-of-pocket expenses in outpatient care and hospitalizations: Baseline surveys of three primary care sites in the Philippines

Background@#The Philippine Primary Care Studies (PPCS) is a network of pilot studies that developed, implemented, and tested strategies to strengthen primary care in the country. These pilot studies were implemented in an urban, rural, and remote setting. The aim is to use the findings to guide the policies of the national health insurance program (PhilHealth), the main payor for individualized healthcare services in the country.@*Objective@#The objective of this report is to compare baseline outpatient benefit utilization, hospitalization, and health spending, including out-of-pocket (OOP) expenses, in three health settings (urban, rural, and remote). These findings were used to contextualize strategies to strengthen primary care in these three settings.@*Methods@#Cross-sectional surveys were carried out using an interviewer-assisted questionnaire on a random sample of families in the urban site, and a stratified random sample of households in the rural and remote sites. The questionnaire asked for out-patient and hospitalization utilization and spending, including the OOP expenses. @*Results@#A total of 787 families/households were sampled across the three sites. For outpatient benefits, utilization was low in all sites. The remote site had the lowest utilization at only 15%. Unexpectedly, the average annual OOP expenses for outpatient consults in the remote site was PhP 571.92/per capita. This is 40% higher than expenses shouldered by families in the rural area, but similar with the urban site. For hospital benefits, utilization was lowest in the remote site (55.7%) compared to 75.0% and 78.1% for the urban and rural sites, respectively. OOP expenses per year were highest in the remote site at PhP 2204.44 per capita, probably because of delay in access to healthcare and consequently more severe conditions. Surprisingly, annual expenses per year for families in the rural sites (PhP 672.03 per capita) were less than half of what families in the urban sites spent (PhP 1783.38 per capita). @*Conclusions@#Compared to families in the urban site and households in the rural sites, households in remote areas have higher disease rates and consequently, increased need for outpatient and inpatient health services. When they do get sick, access to care is more difficult. This leads to lower rates of benefit utilization and higher out-of-pocket expenses. Thus, provision of “equal” benefits can inadvertently lead to “inequitable” healthcare, pushing disadvantaged populations into a greater disadvantage. These results imply that health benefits need to be allocated according to need. Families in poorer and more remote areas may require greater subsidies.

Hospitalization expenses of adult leukemia patients with relapse based on quantile regression / 公共卫生与预防医学

Objective Based on quantile regression analysis, the influencing factors of relapse hospitalization expenses of adult leukemia patients were analyzed. Methods Analyze the composition and influencing factors of hospitalization expenses for leukemia recurrence patients in our hospital. Results From 2017 to 2022 , the per capita hospitalization cost for leukemia patients with recurrence showed an increasing trend year by year. The results of quantile regression model showed that age, payment method , length of stay, times of stay, operation and complications had an impact on the hospitalization expenses of patients at different quantiles, and the difference between different quantiles was statistically significant (P<0.05). Conclusions The quantile regression method can more clearly reflect the distribution of the variables of each factor , we can reduce the hospitalization expenses of patients by improving the coverage rate of medical insurance and controlling the length of stay.

Effect analysis of day surgery cost control based on propensity value matching / 中华医院管理杂志

Objective:To analyze the composition, the changes of expense structure and the influencing factors of hospitalization expenses, for reference in optimizing the cost control of day surgery.Methods:Collection of the first page data of patients with the top three diseases(varicose veins of lower limbs, chronic cholecystitis and varicocele)in the day surgery volume ranking in three tertiary general hospitals in a city in 2020. The confounding factors were eliminated through propensity matching. The structural change of hospitalization expenses was analyzed by structural change degree, and the influencing factors of hospitalization expenses were analyzed by grey correlation degree and multiple linear regression.Results:After 1∶1 propensity matching of the first page data of 752 patients with day surgery and non day surgery, 98 patients with lower extremity varicose veins, 356 patients with chronic cholecystitis and 38 patients with varicocele were finally included. Compared with non day hand, the total hospitalization cost of day surgical instruments decreased, and the cost structure changes of chronic cholecystitis, varicocele and varicose veins of lower limbs were 14.59%, 6.20% and 16.20% respectively. Among them, the general medical service fee, nursing fee and examination and laboratory fee showed a downward trend, and the fees of materials and drugs showed an upward trend. General medical service fee, nursing fee, examination and laboratory fee, clinical diagnosis fee, treatment fee, drug fee, material fee and other expenses presented a high correlation with the cost of day surgery(grey correlation>0.90). The payment method, wound healing type and discharge diagnosis can influence the cost of day surgery( P<0.05). Conclusions:Compared with non daytime surgery, the total hospitalization cost of day surgery has a certain cost control effect, but it can not reduce the cost of all projects. The main influencing factors are the internal composition of the cost, payment method and so on. The hospitals should focus on tapping the internal cost control potential of day surgery and further expanding the coverage of day surgery diseases.

The composition and influencing factors of hospitalization expenses for insured patients with cardiovascular and cerebrovascular diseases / 公共卫生与预防医学

Objective To analyze the composition and influencing factors of the hospitalization expenses of patients with cardiovascular and cerebrovascular diseases who has participated in basic medical insurance, and to provide evidence for controlling excessive increase in the hospitalization expenses and reducing the financial burden of patients. Methods The hospitalization information of 14,271 insured patients with cardiovascular and cerebrovascular diseases from January 1, 2019 to December 31, 2019 in Xianning City, Hubei Province was retrospectively collected. The basic information of the patients and the composition of their hospitalization expenses were descriptively analyzed, and the influencing factors of hospitalization expenses of the patients were analyzed by univariate analysis and logistic regression analysis. Results Among the patients included in the study, coronary heart disease, cerebral infarction, cerebral hemorrhage and essential hypertension were the four main types of cardiovascular and cerebrovascular diseases with the largest proportion of hospitalization expenses, accounting for 26.18%, 20.29%, 11.82% and 9.94%, respectively. The largest proportion of hospitalization expenses was treatment expenses and drug expenses, accounting for 44.09% and 32.52%, respectively. Logistic regression analysis showed that age, length of stay, type of insurance, type of cardiovascular and cerebrovascular diseases, whether there were other comorbidities or complications, and whether they visited tertiary medical institutions were the influencing factors of hospitalization expenses for patients with cardiovascular and cerebrovascular diseases. Conclusion It is necessary to strengthen the disease prevention and control for the elderly and patients with cardiovascular and cerebrovascular diseases such as coronary heart disease, cerebral infarction, cerebral hemorrhage and essential hypertension, accelerate the integration of the basic medical insurance system, scientifically and reasonably shorten the length of hospital stay, and strengthen the promotion of the hierarchical medical system.

Analysis of hospitalization cost and influencing factors of diabetic patients in rural areas of Hunan Province-- Take Wugang as an example / 公共卫生与预防医学

Objective To analyze the composition and influencing factors of hospitalization expenses for diabetic patients，and to provide reference for effective control of medical expenses. Methods The hospitalization cost data of diabetes patients in rural areas of Wugang from 2013 to 2017 were collected. Structural change analysis，non-parametric test and BP (Back Propagation)neural network model were used to analyze the hospitalization expenses and influencing factors. Results The top three components of hospitalization expenses were drug cost (50.02%), examination cost (15.35%) and laboratory cost (12.06%). The contribution rates of structural change of hospitalization expenses were the examination fee (41.00%), drug fee (34.92%) and treatment fee (13.41%), respectively. Factors affecting the total hospitalization cost of diabetic patients included length of stay, operation or not, hospital level, age, discharge year, complication or not and gender (P<0.05), among which length of stay had the greatest impact (sensitivity value was 0.669). Conclusion The hospitalization expenses of patients with diabetes is affected by a variety of factors. It is suggested to optimize the composition of hospitalization expenses by improving the price mechanism of medical services, and to control and reasonably reduce hospitalization expenses by implementing standardized management of clinical pathways, implementing two-way referral and strengthening tertiary prevention.

Analysis on the causes of excessive expenses of inpatients based on DRG: a case study of FC35 disease group / 中华医院管理杂志

Objective:To study the reasons of excessive expenses in hospital and explore the segmented management of the cost of DRG group.Methods:Taking the FC35(coronary artery bypass grafting, without complications and comorbidities)as an example, 1 416 patients of FC35 group discharged from the hospital from June to December 2019 were selected. Taking the average cost of the disease group in the tertiary general hospitals of Beijing in 2019 as the benchmark value, the patients were divided into patients with excessive cost and patients without excessive cost. The hospitalization expenses of the two groups were compared and analyzed, the horizontal comparison between departments and the segmented statistics of patients′ expenses were conducted.Results:In the FC35 group, 614 patients(43.36%)had excessive hospitalization costs. Clinical departments B, D and E had the largest number of cases and the overall cost efficiency was better. Operating room and anesthesiology expenses accounted for 52.77% of the total cost of patients. The cost of high-value tube, high-value line, high-value other, mesh and sanitary materials in the operating room ranked in the top 5.Conclusions:The cost of high value consumables in the operating room is one of the important reasons for the excessive cost of patients.

Regression tree modeling of hospitalization expenses and DRG grouping for unilateral inguinal hernia in children / 中华医院管理杂志

Objective:To explore the variation of hospitalization expenses and its influencing factors under the same main diagnostic disease(children′s unilateral inguinal hernia), and group them based on regression tree model, so as to provide reference for diagnosis-related groups(DRG) grouping of the disease.Methods:The data of the first page of medical records with unilateral inguinal hernia(ICD-10 coding K40.3 and K40.9)as the main diagnosis discharged from a children′s special hospital from 2016 to 2018 were extracted. With hospitalization expenses as the outcome variable and gender, age, operation type, length of hospital stay and complications as the predictive variables, a regression tree model was constructed to classify the children into subgroups.Results:The regression tree model showed that the variables that had a significant impact on the total hospitalization costs were the length of hospital stay, operation type and complications. Age and gender had no significant impact on the hospitalization expenses. According to these three significant variables, the children were divided into five subgroups and the median hospitalization expenses were 1 190.8, 6 387.2, 7 037.7, 11 413.7, and 18 499.1, respectively. Except that the coefficient of variation of hospitalization expenses in group 1 was greater than 1, the coefficient of variation of the other four groups were≤0.5.Conclusions:Children with unilateral inguinal hernia can be divided into groups according to the length of hospital stay, operation type and complications, and the grouping results are relatively reasonable.

Patient blood management: application in complicated adult cardiothoracic surgery / 中国输血杂志

【Objective】 To evaluate the effect of multi-disciplinary patient blood management(PBM) on perioperative blood transfusion in patients with cardiothoracic surgery of gradeⅢ~Ⅳ. 【Methods】 The blood transfusion data and relevant clinical information of adult patients underwent grade Ⅲ~Ⅳ cardiothoracic surgeries before and after PBM (from January 2016 to December 2018)in our hospital were collected using Hospital Information System and Management System of Blood Transfusion Department. Patients were grouped according to three separate12-month periods: 933 cases subjected to conventional blood transfusion practice from Jan. to Dec.2016 as the control group, 1 139 cases experienced initial implement PBM(started on Jan.1, 2017)from Jan. to Dec.2017 as the early PBM group, and 1 411 cases received improved PBM from Jan. to Dec.2018 as the improved PBM group. The perioperative autotransfusion rate, allogeneic transfusion rate, length of hospital stay and hospitalization expenses of the three groups were compared by χ2 test and variance analysis. 【Results】 The comparison results among control group, early PBM group and improved PBM group were as following: 1) The proportion of patients using iron and EPO to treat preoperative anemia were 15.12%(44/291)vs 19.73%(72/365)vs 26.65%(125/469)(P<0.01) and 10.31%(30/291)vs 12.33%(40/365)vs 15.57%(73/469)(P<0.05), respectively. 2) The incidence of autotransfusion were 57.98%(541/933)vs 44.76%(544/1 139)vs 37.00%(522/1 411)(P<0.01). The allogeneic transfusion volume per capita(U) were 351.91±35.85 vs 392.76±43.33 vs 421.75±73.84(P<0.05). The incidence of allogeneic blood transfusion were 18.11%(169/933)vs 17.56%(200/1 139)vs 13.32%(188/1 411)(P<0.01). The allogeneic blood transfusion volume per capita (U) were 6.56±8.33 vs 5.52±6.28 vs 5.56±6.17(P<0.01). 3) The per capita hospital stay (d) and ICU stay (d) were19.54±16.56 vs 16.46±12.06 vs 15.11±10.18 and 4.45±9.31 vs 3.56±6.93 vs 3.26±5.29(P<0.05), respectively. The per capita hospitalization expenses (ten thousand yuan/person) were 10.76±8.39 vs 9.58±7.58 vs 9.13±5.9(P<0.05). 【Conclusion】 The application of PBM in perioperative blood transfusionfor adult cardiothoracic surgery Ⅲ ~ Ⅳcan significantly decrease the incidence of autologous and allogeneic blood transfusion, the length of hospitalstay and hospitalization expenses.

Hospitalization days and costs of patients with acute cholecystitis in different departments by DRGs / 中华医院管理杂志

Objective To analyze the differences in hospitalization days and costs of patients with acute cholecystitis in different departments or diagnosis related groups ( DRGs ), and provide scientific references for clinical medical management. Methods All the medical record homepages of the patients with acute cholecystitis were selected from a tertiary hospital from January 2017 to December 2017. The hospital analysis system of DRGs was used to calculate the classification results of DRGs. The Kruskal-Wallis H test was used to analyze the differences in hospital stays and costs between different DRGs or departments. Results The average length of stay was the shortest and the hospitalization cost in the department of hepatobiliary surgery was lower than other departments among patients with surgery and non-surgical(all P<0.05); The average length of stay at the department of hepatobiliary surgery was lower than the same other DRGs groups, namely the department of digestive medicine and gastrointestinal surgery(all P<0.05). There was no significant difference in the cost of " acute biliary tract disease with complications" between the various departments(P>0.05). The average cost in the department of hepatobiliary surgery was the lowest, and the average cost of gastrointestinal surgery was the highest in two DRGs of " acute biliary disease without complications and concomitant symptoms" and " laparoscopic cholecystectomy without common bile duct exploration" ( all P < 0.05 ). Conclusions Department of hepatobiliary surgery was better than other departments in the treatment of acute cholecystitis. Medical institutions should follow the principle of special treatment to reduce interdisciplinary patients and improve the professional competitiveness of the department.

Analysis of the impacts of drug price markup reform on hospitalization expenses of tertiary public hospitals in Sichuan province / 中华医院管理杂志

Objective To analyze the impact of canceling drug price markup policy on hospitalization expenses of urban public hospitals in Sichuan province and provide decision-making basis. Methods Data of hospitalization expenses of the top 50 diseases among inpatients discharged in 2016 and 2017 were collected, totaling 2 732 022 inpatient cases. Based on hospitalization expenses, these disease were divided into seven categories ( A-G) using dynamic clustering analysis, which represent respectively dominant diseases of different expense makeups, to compare such indicators as hospitalization expenses and composition ratios of these diseases before (2016) and after the reform (2017). Results The study found drastic changes among the medical expenses of different categories of dominant diseases. For example, per-hospitalization cost of categories E ( featuring high drug and examination expenses ) and G ( featuring balanced expenses distribution) diseases decreased since the reform, while the other categories rose instead. The proportion of drugs of different disease categories decreased to various extents. For example, category A ( high drug ratio of 5.60% ) and category E (5.15% ) diseases of which were found with the sharpest drop. Proportion of service expenses, on the other hand, rose to different extents. For example, the proportion of service expenses of all disease categories increased to varying degrees, among which category E (3.46% ), category F (3.37% ) and category D (3.36% ) accounted for the largest share of increase.Conclusions The reform is moving the cost structure of dominant diseases in Sichuan towards a rational level, yet with significant differences among disease categories. The authorities should target various categories to adjust their reimbursement policies, minimize financial burden on patients, strengthen their supervision on drug use and medical behavior, prevent such misbehaviors as the inducing demands and transferring drug markups.

Analysis of hospitalization expenses and influencing factors of acute appendicitis based on grey correlation analysis / 中华医院管理杂志

Objective To analyze the medical expenses of inpatients and its influencing factors in 2014-2016 with acute appendicitis taken as an example, and to put forward policy suggestions for the public hospital reform and the cost control optimization. Methods A total of 4 hospitals were chosen from Zhuhai of Guangdong and Zunyi of Guizhou. 1 114 cases of acute appendicitis were selected to analyze the medical expenses. The influencing factors of hospitalization expenses were analyzed by grey correlation analysis. Results The effect of the cost control of surgical patients was better than non-surgical patients. The total cost of consumables increased obviously. The proportion of non-surgical patients′ drug expenses were 39. 5% , 41. 2% and 41. 7% in 2014 -2016 respectively. The total hospitalization expenses were greatly affected by the treatment expense, diagnostic expense, drug expense, comprehensive medical service expense. The level of medical institutions, age and operation had significant impacts on medical expenses. Conclusions The hospitalization expenses of inpatients with acute appendicitis are influenced by many factors. In order to effectively control the irrational growth of medical expenses, the government is recommended to further strengthen the control of consumables, strengthen the fine management of hospitals and targeted cost control, improve the mechanism of price compensation and deepen the medical insurance payment methods reform.

Investigation on the cross-province settlement of NCMS-covered inpatients in Tianjin:hospitalization cost analysis / 中华医院管理杂志

Objective To analyze the hospitalization costs of new rural cooperative medical system (NCMS)-covered inpatients received by tertiary hospitals in Tianjin with their expenses reimbursed in other localities,for reference of policy making by government departments.Methods NCMS-covered patients who were admitted by 23 tertiary hospitals from May to October in 2017 were followed up and analyzed using their online reimbursement data.Patient expenses were compared among groups of different sources and diseases, using one-way variance analysis and LSD-t for multiple comparison.Results The online reimbursement data of 118 NCMS-covered patients from eight provinces including Liaoning province were collected.The total cost per person averaged 26 744.92 yuan,with 8 890.68 yuan reimbursed,accounting for 33.24%of the expenses incurred.Conclusions The higher proportion of the out-of-pocket payment by patients'results from such factors as higher ratio of non-covered drugs,the lower compensation rate by other provinces on expenses at tertiary hospitals,the medical charges outside the catalog and the medical materials at own expense.Therefore, the compensation policy and medical insurance payment policy should be improved to ensure that the NCMS patients enjoy more reasonable policy treatment.

Analysis on the Influencing Factors of Hospitalization Expenses in 7558 Cases of Patients with Mental Illness / 中国卫生经济

Objective: To analyze the cost of mental illness inpatients in Heilongjiang Neuropathy and Psychopathy Hospital in the past 5 years, to understand the current situation and explore its influencing factors. Methods: The cost composition of 7 558 patients discharged from hospital from 2013 to 2017 was analyzed, and the single factor analysis and multiple factor regression analysis were carried out. Results:The hospitalization cost was increasing year by year, the drug cost ratio decreased year by year, and the treatment cost ratio increased year by year. The main factors that affected the average daily cost of bed, according to its effect on the average daily cost of bed, were: days of hospitalization, emotional disorders(mood disorders), age, patient source, full out-of-pocket expenses, full public expenses and number of hospitalizations. Other mental disorders, schizophrenia, schizophrenia, schizophrenia and paranoid disorders, New Rural Cooperative Medical Insurance. Conclusion: The hospitalization costs of mental illness patients were affected by varied factors, and comprehensive control measures should be adopted to effectively control the increase of medical expenses of inpatients.

Influence of peer support on blood glucose management of type 2 diabetic patients / 中国基层医药

Objective To explore the influence of peer support on blood glucose management of type 2 diabetic patients.Methods From April 2017 to December 2017,the study subjects were selected according to the inclusion criteria from all type 2 diabetes patients who admitted in the Fourth People′s Hosipital of Ningbo.The patients in bed 1-9 were assigned into observation group,and patients in bed 10-20 were assigned into control group.All beds were assigned randomly from a random number generator.Standard diabetes education was provided to both two groups,while peer support was added to the experimental group.The average hospitalization costs and length of hospital stay were compared between the two groups using t-test.Results The average hospitalization cost of the observation group was(6218.48 ±1432.75)yuan,which of the control group was(6913.32 ±1426.34)yuan,the average hospitalization time of the observation group was(6.49 ±1.91)d,which of the control group was(7.41 ±1.99)d,the differences between the two groups were significant(t=-4.480,-4.347,all P<0.01).Conclusion Application of peer support to the glucose management in patients with type 2 diabetes can effectively enhance education effect and reduce hospitalization cost and length of hospital stay.

Application of clinical nursing pathway on medical observation in patients with occupational noise-induced deafness / 中国职业医学

OBJECTIVE: To explore the application effect of clinical nursing pathway( CNP) in nursing care on patients with occupational noise-induced deafness( ONID) under medical observation.METHODS: The patients with ONID under medical observation in hospital were randomly selected and divided into CNP group( 50 cases) and control group( 50 cases) by random number table method.The control group was given routine nursing care,and the CNP group was given CNP care according to the nursing path table.Self-Rating Anxiety Scale,Self-rating Depression Scale and SF-36 Scale were used to observe the anxiety, depression and quality of life of these two groups.The time and expenses of hospitalization,and degree of nursing satisfaction were also observed.RESULTS: Before nursing care implementation,the scores of anxiety,depression and 8 dimension of quality of life did not show statistical significance between these two groups( P > 0.05).After nursing care implementation,the improvement of anxiety,depression and quality of life in the CNP group were significantly better than that of the control group( P < 0.01).The patients in the CNP group had shorter duration of hospitalization( P < 0.01),decreased hospitalization expenses( P < 0.05),and increased nursing satisfaction( P < 0.01) compared with the control group.CONCLUSION: CNP implementation can effectively reduce the anxiety and depression symptoms of patient with ONID under medical observation during the diagnostic process of occupational diseases.It can reduce the time and costs of hospitalization,improve their quality of life and satisfaction of nursing care.CNP can be widely used in clinical practice.

Hospitalization Expenses of Patients with Type 2 Diabetes and their Influencing Factors / 现代医院

Objective To conduct an empirical analysis of constitutes and changes of type 2 diabetes patients′ hospitalization expenses and find out the differences and influencing factors so as to provide hospitals and related departments with the decision basis of controlling medical costs, arranging medical resources and optimizing systems.Methods Information of type 2 diabetes patients who had been admitted to a certain first-class grade one hospital in Ningxia from 2013 to 2016 were collected and categorized.Hospitalization costs and influencing factors of the patients were comprehensively analyzed through descriptive statistics, variance analysis and regression analysis.Results The medicine and examination costs as the constitutes of hospitalization expenses were too high.Gender, length of stay, age and diabetic complications were main contributory factors of type 2 diabetes patients′ hospitalization expenses.Conclusion The costs of hospitalization of patients with type 2 diabetes are unreasonable and need to optimize.Type 2 diabetes patients′ hospitalization expenses should be effectively controlled and medical resources should be reasonably used through standardizing treatment behavior, shortening length of stay, intensifying publicity and education, enhancing prevention and reinforcing follow-ups, expanding health insurance coverage and upgrading its level.

Effect of Different Medical Insurance Payments on the Hospital Performance Index / 现代医院

Objective To analyze the effect of different medical insurance payments on medical expenses so as to provide some suggestions for Guangdong Provincial Department of Offsite Medical Insurance Administration in its future policy-making.Methods An statistic analysis was conducted of medical expenses among patients who chose different medical insurance payments and their average length of stay.Results Medical expenses and average length of stay were statistically different among patients who chose different payments.Conclusion The medicare reimbursement′s inclusion of prevention and diagnosis should be recommended to establish a flexible referral system, reinforce the payments reform and increase the efficiency of social security funds.

Comparative Analysis of the Hospitalization Expenses Before and After the City-level Public Hospital Reform: Taking a Third-level Grade-A Hospital in Anhui Province as an Example / 中国医院管理

Objective To understand the present situation of city-level public hospital reform and to analyze the impacts on different clinical departments by analyzing the changes of hospitalization expenses of a third-level grade-A hospital from Anhui Province.Methods The inpatient data from April to September,2014 and 2015 of the third-level grade-A hospital were collected.Three typical diseases in Department of Internal Medicine,Surgery,Gynecology and Pediatrics respectively,were chosen to compare the changes of expenses and the structure before and after the reform.Results Overall,hospitalization expenses saw a declining trend after city-level public hospital reform.But,it was different in each department.The structure of hospitalization expenses became more reasonable after reform,however,the medical material expense remained a question.Conclusion The city-level public hospital reform reduces drug costs and inspection fees for inpatients effectively,thereby abating the overall cost of hospitalization,and the structure of hospitalization expenses becomes more reasonable.But the changes of hospitalization expenses in different departments reflect some problems.

Grey relational and partial least squares regression analysis on the hospitalization expenses * / 重庆医学

Objective To combine grey relation analysis and partial least squares regression model to establish the forecasting model of per-patient hospitalization expenses .Methods Gray relational analysis was used to filter out the main factors affecting per-patient hospitalization expenses ,and then collinearity was examined between these factors .Partial least squares regression was used to establish prediction model of per-patient hospitalization expenses ,and the prediction accuracy was proved .Results After filtered by gray relational analysis ,the order of the importance of factors affecting per-patient hospitalization expenses was the west-ern medicine fee ,traditional Chinese medicine fees ,diagnosis and treat fees ,other fees ,inspection fees ,bed fees and operation fees . The established partial least squares regression model had a higher accuracy on fitting and prediction ,with low average relative er-ror ,respectively ,-0 .000 2% and 0 .349 3% .Conclusion The gray relational analysis and partial least squares regression are suit-able for the influencing factors and prediction analysis of hospitalization costs .It provides a reference for data with the small sample size and high collinearity between the variables .

Analyzing Pathway of Hospitalization Expense of Fibroid Operation / 中国卫生经济

Objective: To explore the major factors which influence the hospitalization expense of fibroid operation,provide references for the effective control of the increasing medical expense and ease the burden of patients. Methods: From January 2011 to December 2012, 1 837 cases of fibroids in our hospital were investigated, and pathway analysis method was used to analyze the factors which influence the hospitalization expense. Results: Operation method, whether use hysterectomy, the year of medical treatment, complication, medical group and nosocomial infection are the critical influencing factors which can directly effect on the hospitalization expense, and these factors not only have direct effects but also have indirect effects on hospitalization expense. Conclusion:Government and medical institutions should take comprehensive measures to decraease hospitalization expense, including the reasonable treatment options, rational drug use, active treatment and prevention of infection.