Objective To systematically review the impact of Beijing's comprehensive reform of medical consumption linkage on medical expenses, hospital services, and hospital income. Methods Databases including CNKI, WanFang Data, VIP, CBM, PubMed, and Web of Science were searched to collect empirical research on evaluating the impact of Beijing's comprehensive reform of medical consumption linkage on patient medical expenses and hospital operation (service volume and income structure) from June 15th, 2019 to August 15th, 2021. A descriptive analysis was performed after two reviewers independently screened the literature and extracted data. Results A total of 23 studies were included, and most of them found a relatively small change in the average outpatient and emergency medical expenses after the reform. However, the average inpatient expenses in some hospitals showed an increasing trend; the service volume of most hospitals increased slightly, and the income structure was optimized (e.g., surgery and other medical technology services revenue and its proportion increased). Conclusion The comprehensive reform of the medical consumption linkage in Beijing is the practice of deepening the reform of the medical service price mechanism. Based on the summary of the reform effect, it is recommended to further improve the price mechanism, improve service quality, and promote hierarchical diagnosis and treatment.
Objective To explore the serious situation of injection abuse, and its influence to average prescription fee. Methods The subjects of this study were health service settings in rural area of 9 provinces/cities in Midwest of China. The treatment prescription indicators of county and village health service settings were calculated. Results Prescription injection rates of health care facility in rural area of Midwest provinces/cities of China (25.8% to 62.2%,mean: 45.1%) were higher than the standard of WHO (13.4% to 24.1%), and the injection abuse situation was serious. Injection bause caused the increase of prescription fee. Excess usage of injection in health service settings was related to the economic level of the on-site county or village, and also related to the size and load of health service facilities. Conclusion Suggestions are proposed to the government health agency according to the results of the study: enhancing the lawmaking, establishing the related policy and effective measure, training the medical personnel, promoting the mass health education, investigating the effective injection management model in rural area, and reducing the rate of injection.
Objective To provide references to control the cost of stroke inpatients by analysing pertinent factors of stroke inpatients. Methods According to the models of Anderson and Newnan, univariable analysis and multivariable statistical analysis were applied to a number of factors including predisposing factors, enabling factors, and needs factors in 1 969 stroke inpatients of two third level first-class hospitals in Chongqing. Results Among the 1 969 stroke inpatients, 64% had a history of hypertension, and 50% exhibited hypertension during their stay in hospital. Expenditure on medication consumed the highest costs (51%). Length of stay was the most important factor affecting inpatient expense, additional factors were number of surgical operation, nurse type, Rankin score, number of complications etc. Conclusions Complex measures focusing on hypertension to prevent and control of stroke are recommended. Reducing unnecessary stay in hospital and appropriate prescribing are important methods to reduce cost of stroke inpatients.
Objective To Provide statistical references for disease-based payment reform with Diagnosis Related Groups (DRGs). Methods Based on 1 969 stroke inpatients from two hospitals in Chongqing city, we used classification and regression trees (CART) of decision tree to establish classification regulations of the case-mix model for stroke inpatients, and multivariate statistical model to evaluate whether the case-mix could provide a satisfactory prediction to costs for stroke inpatients in comparison with the foreign model. Results ① The classification nodes of our model were surgical procedure, nursing care degree, and hospital infection respectively by which 1 969 stroke inpatients were divided into 5 groups. The classification nodes in foreign model were surgical procedure, age≥50 years, and whether patients would refer to other institutions after leaving the hospitals by which 1 969 stroke inpatients were also classified into 5 groups. ② For medical institutions and the third payers, we found that the data from our model could explain 80.46% of the total costs and 16.58% for individual inpatient, which were higher than that of foreign model (76.87% for medical institutions and the third payers, 9.13% for individuals ). Conclusions Compared with foreign model, our model is more suitable for the situation in China. The study is only based on 1 969 stroke inpatients from south west part of China, so the conclusion needs further studies to confirm.
Objective To analyze the influencing factors of hospitalization costs of obstructive hydronephrosis and explore the optimal grouping of diagnosis-intervention packet (DIP), so as to provide a basis for hospitals to strengthen the cost control of diseases, improve the level of refined management, and improve the compensation mechanism of DIP expenses by medical insurance departments. Methods The homepage data of medical records of Pingshan District People’s Hospital of Shenzhen City from January 2019 to December 2021 were collected, and the information of the discharged patients with the International Classification of Diseases-10th revision code as N13.2 was selected. The factors affecting hospitalization costs were analyzed by single factor analyses and multiple stepwise linear regression, the main surgical methods, number of other operations, and influencing factors of expenses were used as classification nodes, and the decision tree model was used to group and predict costs. Results A total of 1319 patients were included, the median inpatient expense was 10889.59 yuan, and the interquartile range was 10943.89 yuan. The case classification, days of hospitalization, condition of admission, whether it was hospitalized for the first time, whether clinical pathway was implemented, the way of discharge, the number of other diagnoses, and admission path were important factors affecting the inpatient expenses, and 12 groups of case mixes and corresponding expense standards were formed. The reduction in variance was 86.10%, the maximum coefficient of variation was 0.33, and the cost analysis ratio was 96.25%. Conclusions Combining the DIP grouping principle and the multi-factor grouping strategy of diagnosis-related groups, the grouping of obstructive hydronephrosis cases constructed by decision tree model is reasonable and the cost standard is close to reality. The case mixes and cost criteria can provide data support and decision-making reference for hospitals and medical insurance institutions.
Objective To analyze the hospitalization expenses and structure of day surgery diseases between general hospital and traditional Chinese medicine hospital, so as to provide a basis for the reform policy formulation of the payment mode of traditional Chinese medicine medical insurance and the optimization of hospital management. Methods Relevant data such as hospitalization expenses and expenses structure of day surgery of one general hospital and one traditional Chinese medicine hospital in Shanghai between January 1, 2019 and June 30, 2022 were selected. The hospitalization expenses and expenses structure of day surgery in traditional Chinese medicine hospital and general hospital were analyzed. Results A total of 95232 day surgery cases were selected in the case hospitals, including 1389 cases in traditional Chinese medicine hospital and 93843 cases in general hospital. The age of day surgery patients in traditional Chinese medicine hospital was smaller than that in general hospital (P<0.001). The total hospitalization expenses [4379.6 (2293.2, 7563.4) vs. 7629.5 (4467.5, 14154.0) yuan], drug expenses [343.0 (65.0, 1107.0) vs. 749.0 (64.0, 1419.0) yuan], consumables expenses [858.8 (162.2, 1630.1) vs. 1951.0 (620.1, 5720.7) yuan], technical labor expenses [1994.8 (1116.8, 3252.4) vs. 3943.3 (2510.8, 6123.4) yuan] of day surgery patients in traditional Chinese medicine hospital were lower than those of patients in general hospital (P<0.001), and the examination expenses were higher than those of patients in general hospital [432.0 (0.0, 898.5) vs. 40.0 (0.0, 418.0) yuan, P<0.001]. In terms of the total hospitalization expenses structure of patients undergoing day surgery, the proportion of technical labor expenses in traditional Chinese medicine hospital was the highest (42.5%), and the proportion of consumables expenses in general hospital was the highest (43.7%). The specialty of day surgery in the traditional Chinese medicine hospital mainly focused on gynecology, general surgery, anorectal surgery and pain medicine, with the highest average expenses in ophthalmology. The specialty of day surgery in the general hospital mainly focused on urology, biliary, pancreatic and gastrointestinal surgery, ophthalmology and gynecolog, with the highest average expenses in orthopedics. There was no statistically significant difference between the age of patients undergoing hemorrhoidectomy in traditional Chinese medicine hospital and that in general hospital (P>0.05). The total hospitalization expenses [7177.4 (6057.5, 8225.7) vs. 10730.3 (8895.7, 14291.4) yuan], drug expenses [838.0 (441.0, 1342.0) vs. 1532.0 (1335.0, 1698.0) yuan], consumables expenses [4518.7 (4268.3, 5084.9) vs. 5550.9 (4066.6, 8340.7) yuan], technical labor expenses [1138.8 (911.3, 1414.2) vs. 3793.9 (2997.1, 4410.3) yuan] of day surgery patients undergoing hemorrhoidectomy in traditional Chinese medicine hospital were lower than those of patients in general hospital (P<0.05), and the examination expenses were higher than those of patients in general hospital [329.0 (0.0, 598.0) vs. 40.0 (40.0, 40.0) yuan, P<0.05]. In terms of the total hospitalization expenses structure of day surgery patients undergoing hemorrhoidectomy, the highest proportion was consumables expenses both in traditional Chinese medicine hospital and general hospital (63.8% and 53.6%, respectively). Conclusions There are differences between the hospitalization expenses of day surgery in traditional Chinese medicine hospital and general hospital. The dominant disease types of day surgery in traditional Chinese medicine hospitals need to be further cultivated. In the future, when the traditional Chinese medicine medical institutions implement the payment according to the diagnosis-related group/diagnosis-intervention packet, they should fully combine the actual situation of the medical institutions and the characteristics of the disease type, and at the same time, they need to further establish the medical fine management based on the disease type quality evaluation.
ObjectiveTo analyze disease constitution and cost analysis of inpatients in the department of gynaecology of the Chengdu Women's and Children's Central Hospital in 2013, so as to get known of the patients' demands in diagnosis and treatment, and to provide evidence for further studies. MethodsWe collected information of 5 663 cases through medical records in 2013, standardized disease names according to the WHO international classification of diseases (ICD-10), and classified the kinds of diseases according to the first diagnosis of discharge records. Then we adopted the Excel software for data sorting and statistical analysis. Resultsa) Most of the inpatients were women at childbearing age. The diseases pectrum included 13 categories, with the top 3 systematic diseases including diseases during pregnancy/childbirth and puerperium (50.19%); diseases of the genitourinary system (29.31%), and neoplasms (15.54%). b) According to the ICD-10, the top 5 single diseases during pregnancy/childbirth and puerperium were ectopic pregnancy, abortion, missed abortion, threatened abortion, and hyperemesis during pregnancy; the top 5 single diseases of the genitourinary system were endometrial polyps, ovarian endometriosis cyst, uterine adenomyosis, female secondary infertility, and uterus adhesion; the top 5 single diseases of neoplasms were uterine fibroid, ovarian benign tumour, ovarian teratoma, cervical malignant tumour, and cervical carcinoma in situ. c) The average hospital stay in this department in 2013 were 6.31 days, and the average cost per capita were 6 051.10 yuan, with the top 3 kinds of costs including drugs (28.82%), operation (26.32%), and examination (20.09%). ConclusionMost of the inpatients are women at childbearing age in the department of gynaecology of the Chengdu Women's and Children's Central Hospital in 2013. Ectopic pregnancy, abortion and leiomyoma etc., are commonly-seen in this department. The average hospital stay of the inpatients is relatively short. Drugs and surgeries are main costs during hospitalization. Based on commonly-seen gynaecological disease burden, this hospital should urgently need to reinforce the construction of the specialized subjects, look for their own advantages, increase or adjust manpower, material resources and financial investment according to targets, so as to improve the quality and efficiency of medical service.
Objective To investigate the medical charge of in-patients with diabetes and its influencing factors for effective hospital costs controlling. Methods The inpatients with diabetes (the first diagnosis was diabetes; the first three ICD-10 codes of which were between E10 to E14) in Fifth Peoples' Hospital of Chengdu during January to September of 2014 were analyzed for their hospital costs with descriptive statistical method, ANOVA and multiple linear regression method. Statistical analysis was conducted by using SPSS 18.0 software. Results A total of 1 389 cases of diabetes were included. The median of total medical costs and daily costs were 4 554.45 yuan and 446.46 yuan, respectively. The differences of total medical costs and daily costs between diabetes patients with different amount of complications were statistically significant (P<0.001). The factors including age, the way of the medical expense, the number of complications, with acute complications, CCI score and the hospital-stay length were proved to be significantly correlated to total medical costs of diabetes inpatients (P<0.05). Conclusion Age, the way of the medical expense, the number of complications, with acute complications, CCI score and the hospital-stay length are influence factors of medical costs of diabetes inpatients.
ObjectiveTo investigate the variations in patient hospitalization expenses before the enforcement of the centralized procurement policy, after the implementation of the drug centralized procurement policy, and after the introduction of the consumables centralized procurement policy. The efficacy of the centralized procurement policy will also be examined. MethodsThis retrospective study utilizes data obtained from the medical records homepage of the Health Information Statistics Center under the Health Commission of Gansu Province. It included 32 938 inpatients who underwent PCI surgery for coronary heart disease in Gansu province between January 1, 2018, and December 31, 2022. A double-breakpoint interrupted time series model was employed to analyze the fluctuation trends in hospitalization costs among patients across various stages of the centralized procurement policy's implementation. ResultsThroughout the three phases of implementing the centralized procurement policy, the average total hospitalization costs were RMB 46 149.49 yuan, RMB 46 629.12 yuan, and RMB 28 771.76 yuan, respectively. After the centralized procurement policy with a focus on drug volume was initiated, there was an immediate reduction in average total hospitalization costs, drug costs, consumable costs, and medical service fees by 4.64%, 5.62%, 18.12%, and 8.85%, respectively. However, there was a subsequent increase of 25.28% in average medical service fees. Following this phase, average out-of-pocket costs, treatment costs, and other expenses exhibited a consistent upward trajectory, increasing by an average of 2.23%, 1.51%, and 1.21% per month. Upon the introduction of the centralized procurement policy for consumables, there was an immediate surge of 23.75% in average medical service fees, while average total hospitalization costs, out-of-pocket costs, consumable costs, treatment costs, and rehabilitation costs experienced a gradual decline. ConclusionThe enforcement of centralized procurement policies for drugs and consumables has effectively managed to reduce hospitalization costs for patients undergoing PCI surgery due to coronary heart disease, thereby easing the financial burden on patients. However, changes in consumable costs and average medical service fees were relatively modest. Going forward, it is essential to refine the centralized procurement policy concerning consumables, improve the compensation mechanism for medical service pricing, and enhance the overall value proposition of medical services.
Objective To identify the chief factors influencing the hospitalization expenses in fracture patients with health insurance so as to provide information for the control of irrational increase in medical expenses and reform in the mode of medical insurance payment. Methods A total of 113 fracture patients with medical insurance in a hospital of a certain city from September 2006 to April 2007 were included and statistical analysis was performed by using multinomial linear regression analysis. Results The major factors influencing the hospitalization expenses in fracture patients with health insurance included the proportion of material fees and drug fees, length of stay, performance of operations and blood transfusion and etc. Conclusion Lowering the proportion of material fees and drug fees reasonably, reducing the length of hospital stay and avoiding operations and blood transfusion were the key to the control of hospitalization expenses for fracture. It is imperative to speed up and deepen the reform in medical insurance system, formulate scientific diagnostic and treatment routines and clinical pathways as well as expense standards, and try out the payment on certain single disease such as fracture.