| Objective: With the acceleration of China's population aging process,the burden of chronic diseases which is highly related to population aging has also increased.Understanding the current economic burden of chronic diseases and the trends of growth as well as driving factors of the growth of medical expenses is of great significance for promoting the construction of “Healthy China”.This study is based on the System of Health Accounts 2011(SHA2011),which is the latest accounting framework released by OECD.Firstly,the study aims at analyzing the changing trends and driving factors of medical expenses for major chronic diseases in Liaoning Province from 2015 to 2019.Secondly,according to literature researches,the disease range of Ambulatory Care Sensitive Conditions(ACSCs)in Liaoning Province was settled down.Also the study aims at evaluating the scope and distribution of hospitalization expenses for ACSCs.Finally,from the perspective of outpatient and inpatient treatment,the study deems cancer treatment expenses as examples.The expenses for chronic diseases in Liaoning Province were extended as well.And the current distribution of expenses was analyzed.Also some questions related to the distribution are facilitated to come up with measures to control expenses.Methods: First of all,this study is based on the SHA2011 accounting framework to study the current condition of medical expenses for chronic diseases in Liaoning Province,and to analyze the standard and changing trends of treatment expenses for chronic disease in Liaoning Province from 2015 to 2019.The Laspeyres Decomposition method was used to analyze the driving factors of expense development and change,and the main driving factor of expenses were understood by the Degree of Structure Variation method.The second part mainly used the literature research method to determine the disease list of ACSCs in Liaoning Province,and evaluates the scope and distribution of ACSCs in Liaoning Province based on the SHA2011 accounting framework.According to these results of the disease evaluation,the quality of primary medical care was estimated at the population standard in Liaoning Province.The third part adopted the combination of macro and micro research methods to analyze the distribution of outpatient and inpatient expenses for cancer in Liaoning Province,and used the Generalized Linear Model to analyze the influential factors of the average outpatient expenses and the average inpatient expenses of cancer patients.Finally,we put forward targeted cost control measures and policy recommendations.Results: 1.Based on SHA2011,the research on the current condition of medical expenses for chronic diseases in Liaoning Province:(1)From the perspective of the composition of chronic diseases based on SHA2011,the proportion of inpatients with cardiovascular and cerebrovascular diseases is the highest,which is over 50%,followed by cancer patients,diabetes patients and patients with chronic respiratory diseases;And the composition of outpatients is as followed by cardiovascular and cerebrovascular diseases,diabetes,cancers and respiratory diseases.(2)Based on the SHA2011 study on the current status of medical expenses for chronic diseases in Liaoning Province,the four main chronic diseases in Liaoning Province have increased year by year from 2015 to 2019,with an average annual growth rate at 9.5%,of which diabetes treatment expenses have increased the fastest,at the rate of 21.4%,followed by cardiovascular and cerebrovascular diseases and cancers.The cost of treatment of chronic respiratory diseases has declined,with an average annual decrease of 5.2%.In addition,the average hospitalization cost per time for the four chronic diseases increased slightly,while the average outpatient cost per time showed a downward trend.(3)The results of decomposition of growth factors based on the pull factor decomposition method show that from 2015 to 2019,the outpatient treatment costs for the four major chronic diseases in Liaoning Province increased 4,072.95 million yuan,of which the cost increase due to the increase in the number of visits was 1,068,1.62 million yuan.The cost was reduced by 1,126.54 million yuan due to the reduction of the average cost per visit.The combined effect of the two led to a reduction of 5,482.15 million yuan.The outpatient treatment costs were mainly caused by the increase in the number of visits.The cost of hospitalization for the four major chronic diseases in Liaoning Province has increased by 7,354.16 million yuan,of which the cost increase due to the increase in the number of hospitalizations is 4,366.62 million yuan,and the cost increase due to the average cost increase is 2,161.08 million yuan,due to the combined effect of the two was826.46 million yuan,and the treatment expenses of inpatient treatment expenses were mainly caused by the increase in the number of visits and the increase in average expenses per visit.(4)Based on the analysis of changes in the structure of medical expenses for chronic diseases,the average hospitalization expenses for the four major chronic diseases in Liaoning Province increased slightly from 2015 to 2019.Among those,the medical expenses showed a downward trend,with an average annual decrease of nearly 8%.Other expenses are on the rise,and labor costs such as surgery,nursing,laboratory tests,and treatment have increased rapidly.The average cost of outpatient visits dropped by 95.8yuan,mainly due to the decrease in drug costs and inspection costs.Among them,the cost of medicine decreased by 72.6 yuan,accounting for 75.8%,and the cost of inspection decreased by 20.6 yuan,accounting for 21.5%.2.A study of avoidable hospitalization costs for chronic diseases in Liaoning Province based on SHA2011:(1)From 2015 to 2019,a total of 266,000 patients with ACSCs in Liaoning Province,the avoidable hospitalization rate was 6.0%,and the avoidable hospitalization rate has a trend of increasing year by year;ACSCs patients hospitalized expenses are 12.44 billion yuan,accounting for 4.0% of the province total hospitalization expenses.(2)The number of male ACSCs patients is higher than that of females(136,000 cases vs.130,000 cases),and the avoidable hospitalization rate is also higher than that of women(6.8% vs.5.3%).(3)The number of ACSCs patients and hospitalization expenses are mainly distributed in provincial and municipal hospitals,but the avoidable hospitalization rate for chronic diseases in district and county hospitals and primary medical institutions is relatively high.(4)The number of patients with diabetes accounted for 54.4% of all ACSCs patients,and the avoidable hospitalization expenses accounted for about 50% of the avoidable hospitalization expenses for all chronic diseases.(5)ACSCs patients are mainly concentrated on people aged 40 and over.The number of patients and hospitalization expenses account for more than 90% of all chronic diseases that can be avoided hospitalization,and the rate of avoidable hospitalization increases with age.(6)The average hospital stay of patients with ACSCs(10.1 days)was higher than the average hospital stay of patients with non-ACSCs(9.7 days),and the average hospitalization cost of patients with ACSCs(8,238.6 yuan)was lower than that of patients with non-ACSCs(12,497.9 yuan).3.The third part of the research on cancer medical expenses from the perspective of outpatient and hospitalization expenses distribution:(1)The top 10 cancers in Liaoning Province are lung cancer,colorectal cancer,breast cancer,gastric cancer,cervical cancer,thyroid cancer,liver cancer,uterine body cancer,kidney cancer and lymphoma.Among them,male treatment costs mainly occur in lung cancer,colorectal cancer,stomach cancer,liver cancer,bladder cancer and prostate cancer.The cost of treatment for women mainly occurs in breast cancer,lung cancer and colorectal cancer,cervical cancer,uterine body cancer and thyroid cancer.From the perspective of patients' age,the expenses for people under 40 are mainly concentrated in thyroid cancer,cervical cancer and leukemia,the expenses for people aged 40-54 are mainly distributed in breast,lung and cervical cancer,and the expenses for people aged 55-69 are mainly distributed in lung cancer.colorectal cancer and breast cancer,while the cost of people over 70 years old is mainly distributed in colorectal cancer,lung cancer and gastric cancer.(2)In 2019,the cost of cancer treatment in Liaoning Province was 12,868 million yuan,accounting for 11.5% of the total treatment cost in Liaoning Province.The average hospitalization cost per-time for cancer was 21,069 yuan,and the average outpatient cost per-time was 505 yuan.The average cost of different types of cancer varies greatly.The average out-of-pocket expenses per hospitalization were 12,638 yuan,accounting for 60% of the average hospitalization expenses.The out-of-pocket expenses for outpatient visits were 322 yuan,accounting for62.5% of the average outpatient expenses.The out-of-pocket ratios of different types of cancer are significantly different,and the share of out-of-pocket cost for outpatient is higher than the share of out-of-pocket cost for inpatient with any disease.(3)The cost of cancer treatment in Liaoning Province is mainly concentrated in inpatient services,accounting for 79.2% of the total cost.The distribution of outpatient inpatient expenses for different diseases is quite different.Among them,outpatient expenses for breast cancer,lymphoma and other diseases account for a relatively high proportion,accounting for about30% of the total expenses,while outpatient expenses for diseases such as gastric cancer and thyroid cancer account for relatively low,less than 10%.The cost of medicines and materials accounted for the highest proportion of hospitalization expenses,followed by surgery fees,inspection fees,and laboratory tests.Among outpatient expenses,drug expenses accounted for the highest proportion,followed by inspection and laboratory testing expenses.The cost composition of different cancer types is slightly different.The hospitalization costs for breast cancer and lymphoma are mainly composed of medicines,examinations,laboratory tests,and material costs.The hospitalization costs for gastric cancer are mainly composed of medicines and materials.The costs of thyroid cancer are mainly composed of Surgery fees and material costs constitute.(4)The results of a case study based on the influencing factors of the average cost of cancer per visit from the perspective of outpatient and inpatient treatment show that whether surgery,the type of medical insurance payment,and the type of hospital have a significant impact on the average cost of outpatient and inpatient visits for the four types of cancer.Gender and age have different effects in different cancer and outpatient services.Generally speaking,the cost of surgical patients is significantly higher than that of non-surgical patients.Patients with urban employee basic medical insurance have a higher average cost per patient than other types of medical insurance.In addition,in inpatient services,the average cost per time in general hospitals is significantly higher than that in specialist hospitals and Chinese medicine hospitals;and in outpatient services,Chinese medicine hospitals have higher costs.Conclusion: 1.The first part of the study showed that from 2015 to 2019,the medical expenses for major chronic diseases in Liaoning Province have increased significantly.The increase in the number of visits is the main reason for the increase in the cost of treatment of chronic diseases.The better control of the average cost per time has made the actual increase in the treatment cost of certain chronic diseases lower than the expected level under the condition of constant cost per time,and effects of cost control have been achieved to some extent.However,as the cost of chronic disease treatment continues to increase,targeted measures still need to be taken to control it.2.The second part of the study indicated that the phenomenon of avoidable hospitalizations for chronic diseases in Liaoning Province is relatively large,and it is mainly concentrated in those admitted in provincial and municipal hospitals,or people with diabetes,and people over the age of 40.The medical insurance payment method should be optimized,and a comprehensive hierarchical diagnosis and treatment model should be gradually established.The role of primary care management for key populations and diseases should be strengthened.Multiple measures should be taken to control the occurrence of hospitalizations to reduce the burden on patients and the society and economy.3.The last part of the study suggest that in terms of cancer treatment,inpatient and outpatient services have unreasonable cost patterns,and patients rely excessively on inpatient services for treatment.Relevant policies need to be adopted to promote the transfer of cancer care to outpatient clinics in many ways,so as to effectively and rationally use health resources and control treatment costs of cancer. |
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