Information analysis of patients with allopatry direct settlement of medical insurance at an oncology hospital / 中华医院管理杂志

ABSTRACT

Objective To propose on and improve direct settlements by medical insurance offices and hospital systems in their processing of medical treatment in allopatry (MTA), by analyzing such data as the homepages of medical records of such inpatients at a tertiary cancer hospital with their medical expenses settled directly. Methods Data of 6 379 MTA inpatients with direct settlements of in-hospital fees from April 2017 to March 2018 were included in this study. Such data were used to identify the change trend of their case counts and their regional distribution, and analyzed with hierarchical clustering to calculate the settlement counts of various provinces. Results Analyses found that the total cases of such patients remained stable at the hospital, yet the cases of direct settlement rose from five to 1 263, and the proportion of direct settlement among all MTA inpatients rose month by month from 0.14% to 29.26%. Most of MTA inpatients come from Hebei, Shandong, Inner Mongolia and Shanxi provinces in turn, yet the direct settlement counts and hospitalization case trends appear different. Clustering results indicate Hebei as the type-1 province with the highest proportion of direct settlement inpatients, accounting for 30. 41% ;Shandong, Inner Mongolia and Shanxi as the type-2 provinces, accounting for 15. 05% , 13. 45% and 11.00% respectively; Liaoning, Henan and Heilongjiang as the type-3 provinces, accounting for 6.79% , 4.81% and 4.42% respectively; while the rest provinces as the type-4, accounting for less than 3%. Conclusions Regional distribution varies distinctively among such inpatients, and the number of these inpatients keeps rising stably. In such circumstances, hospitals are recommended to enhance their management in strengthening medical insurance audit systems, speeding up settlement, and building regional medical alliances.