Objective To investigate the disease constitution and cost of inpatients in Gaozha Central Township Health Center (GzC) in Wuzhong City of Ningxia Hui Autonomous Region from 2008 to 2010, so as to provide baseline data for further research. Methods A questionnaire combined with a special interview was carried out, and case records and cost information of GzC inpatients in 2008, 2009 and 2010 (from January to November) were collected. The diseases in discharge record were classified according to International Classification of Diseases (ICD-10) based on the first diagnose and the cost was analyzed. Data including general information of the inpatients, discharge diagnosis, hospitalization expenses, and drug cost etc. were rearranged and analyzed by Excel software. Results a) The total number of the inpatients was 1124, 642 and 747 in 2008, 2009 and 2010, respectively. The female was more than the male in both 2008 (59.34% vs. 40.66%) and 2009 (60.75% vs. 39.25%), and their disease spectrum included 17 categories, which accounted for 81% of ICD-10; b) The top six most commonly seen systematic diseases with a constituent ratio from 86.63% to 92.06% in recent three years were as follows: the respiratory system, digestive system, circulatory system, genitourinary system, injury and toxicosis, skeletal musculature and connective tissue disease. Except the injury and toxicosis, the other five systematic diseases were commonly seen in females rather than in males; c) The top 15 monopathies in recent three years were pulmonary infection, tracheitis or bronchitis, coronary heart disease, soft tissue injury, gastritis or chronic gastritis, upper respiratory infection, hypertension, urinary tract infection, prolapse of lumbar intervertebral disc, pelvic inflammation, fracture, pneumocardial diseases, superficial injury, chronic cholecystitis and arthritis; d) The main burdens of disease for inpatients focused on 35-54 age groups, then followed by the age groups above 55 in 2008 and 2009. Except the injury and toxicosis, the other diseases were commonly seen in females rather than in males. Pulmonary infection focused on the age groups above 35; the onset of hypertension increased obviously and a sharp rise of hypertension existed in the 45-54 age groups in 2008, but the hypertention focused on 35-44 age groups in 2009; e) The total inpatients with top 15 monopathies accounted for 64.06% to 71.21%, including 8-9 chronic diseases ranking higher in 2010, and 6-7 acute diseases focusing on infection and injury; and f) The average costs of chronic diseases were higher than those of acute diseases. Conclusion a) There is a big gap between GzC and Yong’an Central Township Health Center (YaC) regarding the level of the regional economic development, the situation of disease burden and cost of inpatients. The former is demonstrated as general Central Township Health Center, while the latter as affluent Central Township Health Center in western China; b) In recent three years, the main systematic diseases are in respiratory, circulatory and digestive system; the inpatients suffer from more chronic diseases rather than acute diseases in their young age; the acute diseases mainly include infection and injury, and the pulmonary infection has ranked as the first during the past three years; c) The inpatients in 2008 and 2009 are mainly in ages of 35 to 54, and then are over 55 years old. Except the injury and toxicosis, the other diseases were commonly seen in females rather than in males; d) The patients’ average costs of chronic diseases for hospitalization and drug in 2010 were lower than those of YaC. Consideration on reasonable constitution of the cost for hospitalization should be paid attention to; and e) It is urgent to strengthen the construction of infrastructure and informatization in GzC.
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 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.
Objective To investigate the variation of total hospitalization cost for single-diagnosed disease of different types of acute appendicitis in a three-A hospital, so as to provide evidence for the reimbursement amount of social medical insurance. Methods All patients with acute appendicitis who had surgery treatment during January-April 2011 (before implementing the fee system for single-diagnosed disease) and January-April 2012 (after implementing the fee system for single-diagnosed disease) were collected in this study for analysis. According to the types of acute appendicitis, the patients were stratified into the low risk group (simple, suppurative and gangrenous) and the high risk group (perforative, abscess-formed and pregnancy-combined). The correlation between total hospitalization cost and types of acute appendicitis, as well as the changes of total hospitalization cost after implementing the fee system for single-diagnosed disease were analyzed. Results A total of 90 eligible patients were included. The disease types were positively correlated with hospital stays and total hospitalization cost. All three types in the low risk group could control the average total hospitalization cost within RMB 10 000 yuan. The results of sensitivity analysis showed that, before implementing the fee system for single-diagnosed disease, the total hospitalization cost up to RMB 6 000 yuan could be positively correlated with the above risk stratification (r=0.442, P=0.003). After implementing the fee system for single-diagnosed disease from January to April 2012, the constituent ratio of hospital stays, compared with that in the same period of 2011, had no significant difference (P=0.108) between the two groups; but the ratio of hospital stays (less than 5 days) increased from 45% to 64%, and the ratio of hospital stays (greater than or equal to 10 days) decreased from 17% to 4%, indicating a tendency of shortening hospital stays. Also, the constituent ratio of total hospitalization cost had no significant difference (P=0.114) between the two groups; but the ratio of total hospitalization cost (greater than or equal to RMB 9 000 yuan) decreased from 32% to 13%, indicating a tendency of lowering total hospitalization cost. Conclusion The low risk group of acute appendicitis, RMB 6 000 yuan should be rated as the rational reimbursement amount of social medical insurance. The total hospitalization cost for the high risk group is quite various, so the further studies are needed to investigate the feasibility of the fee system for single-diagnosed disease as well as the rating amount of total hospitalization cost. The implementation of the fee system for single-diagnosed disease is helpful to shorten hospital stays and reduce total hospitalization cost.
ObjectiveTo investigate constitution and financial burden of disease in the West China Hospital of Sichuan University during 2011-2012. MethodsThe data of in-patients (who had been discharged from the department of endocrinology and metabolism or discharged after being transferred to other departments for diagnosis and treatment in the West China Hospital from January 2011 to April 2012) were collected from the Hospital Information System (HIS) of the West China Hospital, including basic information, discharge diagnosis, hospital costs, the information about whether the patients had been registered the insurance in hospital, etc. We classified diseases according to ICD-10 based on each diagnosis when the patients were discharged on the first page of case reports. The data were input using Excel 2010 software, and statistical analysis was performed using SPSS 13.0 software. Resultsa) During 2011-2012, in the department of endocrinology and metabolism, the top five commonly-seen diseases of in-patients were:diabetes, followed by hypothalamic-pituitary-adrenal/gonadal disease, diseases other than endocrine disorders, thyroid disease, and metabolic bone disease. b) The diseases of the top five average hospital stay included:diabetes, followed by malnutrition, metabolic bone disease, diseases other than endocrine disorders, and hypothalamic-pituitary-adrenal/gonadal disease. c) The diseases of the top five total costs of included:diabetes, followed by metabolic bone disease, diseases other than endocrine disorders, malnutrition, and other nutrients deficiency. ConclusionDiabetes and its complications are the major disease as well as the major cause of the burden of disease in the in-patient department of endocrinology and metabolism of the West China Hospital of Sichuan University.
ObjectiveTo 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.MethodsThe 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.ResultsThere 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 (P<0.05); the costs of examination, laboratory , bed, drug, and others were basically stable, and the differences were not significant (P>0.05).ConclusionThe 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.
ObjectiveTo explore the relationship between the proportion of hospitalization expenses and the rationality of expense structure in patients with chronic heart failure (CHF), providing reference for early warning of unreasonable hospitalization expense structure and reasonable control of patients’ hospitalization expenses.MethodsPatients with CHF between 2020 and 2023 in Shanghai Pudong New Area Guangming Hospital of Traditional Chinese Medicine were used as the study data. Percentile algorithm was used to judge the rationality of the hospitalization expense structure. Multivariate logistic regression model was used to analyze the correlation between the proportion and rationality of expense structure. Restricted cubic spline model was to analyze the threshold response relationship. ResultsA total of 762 patients were included. The medicine expenses remained the primary component of hospitalization expenses for patients with CHF, and combined expenses of examination and laboratory tests exceeded 80% of the total hospitalization expenses. The incidence of unreasonable hospitalization expense structure in patients with CHF was about 10%. The proportion of traditional Chinese medicine, western medicine, examination and laboratory tests, age, admission mode and clinical pathway were the influencing factors of unreasonable hospitalization expense structure in patients with CHF. After coordinating the relevant variables, when the proportion of examination and laboratory tests was <35%, the risk of unreasonable hospitalization expense structure decreased with the increase of the proportion [odds ratio=0.887, 95% confidence interval (0.805, 0.977), P<0.01]. While the proportion of western medicine expenses was >30%, the proportion of traditional Chinese medicine expenses was >13%, and the proportion of examination and laboratory tests was>35%, the risk of unreasonable hospitalization expense structure increased with the increase of proportion (P<0.01). ConclusionsThere is a correlation between the expense proportion of medicine, examination and laboratory tests and unreasonable hospitalization expense structure. The consumptive expenses should be reasonably controlled.
Objective To investigate the association between costs of hospitalized patients with diabetes mellitus and their complications in the West China Hospital of Sichuan University, so as to provide baseline data for further research. Methods We extracted the hospitalization case data of hospitalized patients with diabetes mellitus who were discharged from the department of endocrinology and metabolism, or discharged after being transferred to other departments for treatment from January 2011 to December 2012, using the hospital information system (HIS) of the West China Hospital of Sichuan University. The data included baseline of hospital patients, discharge diagnosis, hospitalization costs, and if their medical insurance had been registered in hospital. Then, we classified the diseases according to ICD-10 based on discharge diagnosis, coped the data using Excel 2010 software, and conducted statistical analysis using SPSS 13.0. Results a) In 2011, acute and chronic diabetes complication in diabetes inpatients were 11.9% (166/1 396) and 67.1% (930/1 396), respectively. Most of them had peripheral neuropathy and peripheral vascular disease. b) The most frequently-occurred complications were hypertension, followed by dyslipidemia, and osteoporosis. c) The median hospital stay was 13 days (7 to 9 days), and the median total cost of hospital/person-time was 6 578.88 yuan (4 186.93 to 10 953.89 yuan). d) The total cost and duration of hospitalization increased along with the increasing number of the chronic complications of diabetes. e) The diabetic foot patients were 255 person-times, the median duration of hospitalization was 18 days (13 to 29 days), and the median total cost of hospital/person-time was 16 672.19 yuan (10 903.93 to 28 530.37 yuan). Diabetes patients with foot complication had higher total costs and longer duration of hospitalization than those without foot complication. Conclusion Diabetes mellitus is one of the most important diseases in the department of endocrinology and metabolism, which is heavy disease burden. The costs of hospitalization and chronic complications are closely associated. Among these complications, diabetic foot is the heaviest disease burden.
Abstract Objective To investigate the disease constitution and hospitalization expenses in Songqiao Central Township Health Center (SqC) in Gaoyou City of Jiangsu Province in 2010, so as to provide the baseline data of disease burden for further study. Methods The inpatient records of SqC in 2010 were collected. The first discharge diagnoses were classified according to the International Classification of Disease 10 (ICD-10). The general information of the inpatients, discharge diagnosis, hospitalization expenses, disease category, age, gender, and reimbursement of expenses were described and analyzed by using Microsoft Excel 2003 and SPSS 13.0 software. Results a) The total number of inpatients was 1036 in 2010, and the gender ratio was about 1.0 (50.7% vs. 49.3%); b) The disease spectrum included 17 categories. The cumulative percents of the top 5 systematic diseases were 81.2%, including the respiratory, digestive, neoplasm, circulatory diseases, and injury, poisoning amp; external causes; c) The top 15 diseases were pneumonia, fracture, malignant neoplasm, benign neoplasm, acute bronchitis, cerebral infarction, hypertension, acute appendicitis, emphysema, cholecystolithias accompanied with cholecystitis, inguinal hernia, coronary heart disease, diabetes mellitus, chronic bronchitis and superficial injury; d) The patients suffering from pneumonia and acute bronchitis were mainly over 65 years old and younger than 5; e) The number of chronic diseases significantly increased with age, especially after the age of 35 years old, and reached the peak at the age over 65 years old; while the acute diseases were mainly distributed at the age younger than 15 yeas old and older than 65 years old. The average length of stay, the total hospitalization and out-of-pocket expenses per capita of the chronic diseases were more than those of the acute ones (13.8 days vs. 9.9 days, ? 3 082 vs. ? 2 615; ? 417 vs. ? 371, respectively); f)The length of stay and total hospitalization per capita were quite higher than the other township health centers (11.6 days vs. 5.2 days, ? 3 001.4 vs. ? 1 004.6); and g) Both of the total reimbursement and out-of-pocket expenses per capita accounted for 44%-57% of the total hospitalization expenses. Among the total reimbursement, the payment from New Cooperative Medical Scheme (NCMS) accounted for over 99%, while that from Medical Aid Scheme only accounted for less than 2%. Conclusion a) The top 3 systematic diseases of SqC are seen in respiratory system, digestive system and neoplasm. The acute diseases are mainly pneumonia and fracture; b) The number of acute or chronic diseases increases significantly with age, especially after 35 years old. Both adolescents and the aged suffer from the heaviest burden of diseases; c) The average length of stay and hospitalization expenses pre capita of SqC are much higher than those of the other township health centers; and d) NCMS is the major source of reimbursement. However, the proportion of out-of-pocket expenses and the burden of diseases are still very high and heavy. Thus the policy of NCMS needs to be adjusted step by step in future.