| Section 1 Existing circumstances of economic burden of malignancy in GuangxiObjective: To investigate the circumstances on economic burden of malignancy in Guangxi,to master the economic burden level of common malignant tumor disease and their characteristics in Guangxi,so as to provide a scientific basis for administrative department of public health to make policy and measures to prevent and control cancer and allocate the health resources reasonably.Methods:1.Data collection:(1)a sampling survey based on hospital was carried out in 4 class ? Grade I hospitals in Nanning Guangxi from August 2013 to December 2014 by questionnaire.The information include the cost of seeing the doctor,treatment cost,traveling expenses,self-paying medicine,nutrition purchase,escort service and accommodation.(2)Using the?National Network Direct Report System for Health Statistics ? to collect information of all hospitalized cancer patients(ICD10 code C00 to C97,D00 to D09)in Guangxi from 2010 to 2013,including name of hospital,payment method,hospitalized times,case number,admission date,discharge date,patients' name,sex,age,marital status,profession,ICD-10 code,patients situation,traditional medicine expense,west medicine expense,disease situation by the patients and hospitalization expenses,etc.(3)Using the Guangxi Zhuang Autonomous Region Bureau of statistics web site to collect 2010 to 2013 GDP,GDP per person,general income of urban and rural residents in Guangxi,demographic data,etc.(4)Using of the Guangxi Zhuang Autonomous Region health and family planning commission website collect outpatient expenses,the total health expenses,etc.2.Economic expense calculation(1)Direct medical cost: Direct medical cost include hospitalize cost and outpatient cost.Hospitalized cost according to gather all of the malignancy hospitalized patients' total cost,outpatient cost according to per capita treatment times and per capita outpatient cost from sample survey.(2)Direct non-medical cost: according to calculate patients' travelling expenses,self-paying medicine,nutrition expenses,escort service and per capita accommodation.(3)Indirect economic burden: on the basis of DALYs combined human capital to calculate.DALYs calculation according to Chinese male,female and both sexes summarized cases and DALYs of 28 types of malignancy in 2013 offered by tumor cooperation team of GBD.Calculate every patients' DALYs of differences between sexes,types of malignancy.According different types of malignancy cases to calculate DALYs of malignancy in Guangxi.Calculating indirect economic burden base on malignancy DALYs,GDP in Guangxi and different age groups' productivity weight.Result:1.Sampling survey of malignancy patients in hospital.621 hospitalized malignancy patients in total were participated in this sampling investigation.Among them,there were 405 males and 216 females,and the ratio of male to female is 1.88:1.The median of age was 50,median of outpatient times was 3,Median of hospitalized cost is 20500.00 RMB,median of self-paying medicine was 4000.00 RMB,median of health care products was2500.00 RMB,and median of escort days was 28.Medical insurance focus on new rural cooperative medical system(NCMY),account for 66.2%,the second was urban employee's basic medical insurance,account for 27.1%.2.Malignant tumor patient's schemes: Hospitalization in a total of 75139 patients with malignancy in Guangxi in 2013,of them,male 43825 cases,accounting for 58.32%,female 31314 cases,accounting for 41.67%.The average age of male was 56.91±15.47,and the average age of female was53.72±15.26.Average age of the male patients is higher than female patients.3.DALYs and the DALYs rate of primary malignancy:The DALYs of malignancy patients were 1281343.91 person-year,and the DALYs rate was24.26 person-year per1000.The DALYs for male patients was 844026.46person-year,and the DALYs rate was 30.45 person-year per1000.The DALYs for female patients was 440347.64 person-year,the DALYs rate was 17.54person-year per1000.The DALYs of male patients is almost twice as female patients.In all the patients,DALYs and DALYs rate of the top five malignancy was: liver cancer(310396.76 person-year and 5.88 person-year per1000),lung cancer(210764 person-year and 4.02 person-year per1000),nasopharyngeal carcinoma(106764.79 person-year and 2.02 person-years per1000),colorectal cancer(82151.53 person-year and 1.56 person-years per1000),and stomach cancer(79828.73 person-year and 1.51 person-years per1000).The DALYs of five kinds of malignancy was 791249.72 person-years,accounted for 61.75% of all malignancy.4.Age distribution of DALYs: The DALYs of 0-14 age group was 23181.34person-year,accounting 1.81%;The DALYs of 15-44 age group was 261056.33person-year,accounting 20.37%;The DALYs of 45-59 age group was461220.84 person-year,accounting 36.00%;The DALYs of above 60 age group was 535885.40 person-year,accounting 41.82%.5.Hospitalization expenses: The total hospitalization expenses was 1.357billion(in comparable price)for 75139 patients with malignancy in Guangxi in2013.The top five hospitalization expenses of malignancy are: liver cancer(1.69 hundred million yuan),colorectal cancer(1.62 hundred million),lung cancer(1.58 hundred million yuan),nasopharyngeal carcinoma(1.54 hundred million yuan),breast cancer(0.83 hundred million).The top five average hospitalization expenses: brain and nervous system cancer(24597.00 yuan),colorectal cancer(20365.77yuan),cervical cancer(17469.01 yuan),nasopharyngeal carcinoma(16239.87 yuan),kidney cancer(15830.50 yuan).6.Outpatient service fee: The outpatient service fee was 0.23 hundred million RMB,account for 1.67% of the direct medical expenses(1.38 billion).7.Direct non-medical expenses: The total direct non-medical expense was5.36 hundred million yuan,of them,self-paying medicine was 2.75 hundred million yuan,account for 51.31% of direct non-medical expenses.The second was self-paying health product expenses,1.72 hundred million yuan,accounting for 32.09% of the total direct non-medical expenses.8.Indirect economic burden: The indirect economic burden is 19.071 billion yuan.The top 5 indirect economic burden of malignancy were: liver cancer(5.17 billion yuan),lung cancer(2.451 billion yuan),nasopharyngeal carcinoma(2.082 billion yuan),leukemia(1.09 billion yuan),colorectal cancer(1.003 billion yuan),respectively.There was 11.796 billion of indirect economic burden by these 5 types of malignancy,accounting for 61.85% of total indirect economic burden.Escort lead to indirect economic burden is 1.33 hundred million.9.Total economic burden of malignancy: Total economic burden of malignancy was 21.12 billion RMB(calculated at comparable price)in Guangxi in 2013,accounting for 1.47% of the Guangxi GDP 1437.8 billion,accounting for 24.90% of the Guangxi total expenditure on health 84.823 billion in the same year.The hospitalization medical treatment charge 1.380 billion RMB,accounting for 6.53% of the total economic burden,direct non-medical costs5.36 million RMB,accounting for 2.54%,indirect economic burden is 19.204 billion RMB,accounting for 90.93%.Conclusion: The disease burden and economic burden of malignancy in Guangxi were heavy,the liver cancer,lung cancer,nasopharyngeal carcinoma,gastric cancer,colorectal cancer,breast cancer,etc were main malignancy in Guangxi.Limited health resources should be allocate to prevent and treatment these malignancy,practical and effective measures should be adopted to reduce the morbidity and mortality of malignancy,maximum limit to reduce the burden of malignancy and harmful to health.Section 2 Variation tendency of economic burden of malignancy in GuangxiObjective: To investigate the variation tendency of economic burden and it`s characteristics of the malignancy and situation of the major malignancy in Guangxi from 2010 to 2013,to master the malignancy disease spectrum and the level of economic burden in Guangxi,in order to provide a scientific basis for developing the prevention and control measures of the main malignancy.Method: Using the?National Network Direct Report System for Health Statistics?to collect information of all hospitalized cancer patients in Guangxi from 2010 to 2013,screening malignancy patients base on ICD-10(C00 to C97,D00 to D09)and collecting the data by sampling survey on the hospitalized malignancy patients.According to collected data to calculate DALYs and the DALYs rate,direct medical cost,direct non-medical costs,indirect economic losses and so on.The the average annual development speed and growth speed were calculated for DALYs,DALYs rate,direct medical costs and indirect economic burden.Result:1.Malignancy scheme from 2010 to 2013 in Guangxi: Hospitalization patients with malignancy from 2010 to 2013 were 62515,68191,81178,75139,respectively,increasing by years.The ratio of sex of cancer patient was constant,male accounting for about 60.0%,and female accounting for about 40.0%.The average age of male patients was about 57,and female was about 53.Male patients with an average age of about 57 and female with an average age of about 53.2.DALYs and DALYs rate from 2010 to 2013 in Guangxi: From 2010 to2013,DALYs for malignancy in Guangxi was 1096391.08 person-years,1197991.18 person-years,1420839.27 person-years and 1281343.91person-years,respectively.The DALYs rate was 21.25 person-year per1000,23.0 person-year per1000,27.12 person-year per1000 and 24.26 person-year per1000,respectively.There is an annual increasing tendency for this 4 years for DALYs and DALYs rate.The average development speed for DALYs was113.84% and the average growth speed was 13.84%.The average development speed for DALYs rate was 112.97% and the average growth speed was 12.97%.Base on the DALYs rate,the top 5 malignancies in Guangxi were: liver cancer,lung cancer,nasopharyngeal carcinoma,stomach cancer,colorectal cancer or leukemia,the DALYs rate was between 6.90 person-year per1000 to 1.40person-year per1000.3.The medical costs of hospitalization patients with malignancy from 2010 to2013 in Guangxi: The total medical costs of hospitalization patients with malignancy from 2010 to 2013 in Guangxi(calculated on comparable price)were: 8.79 hundred million,9.19 hundred million,12.72 hundred million,13.57 hundred million RMB,respectively.There is an annual increasing tendency for this 4 years.The average development speed is 115.59%,and the average growth speed is 15.59%.4.The indirect economic burden of malignancy from 2010 to 2013 in Guangxi: The indirect economic burden of malignancy from 2010 to 2013 in Guangxi were 10.886 billion,14.647 billion,19.512 billion,19.07 billion RMB,respectively.There is an annual increasing tendency for this 4 years.The average development speed is 120.55%,the average growth speed is 20.55%.5.The total economic burden of malignancy from 2010 to 2013 in Guangxi:The total economic burden of malignancy from 2010 to 2013 in Guangxi were12.330 billion,16.140 billion,21.478 billion,21.120 billion RMB,respectively.There is an annual increasing tendency for this 4 years.The average development speed is 119.57%,the average growth speed is 19.57%.Conclusion: There is an annual increasing tendency for malignancy economic burden in Guangxi,The annual average growth rate of direct medical costs is 15.59%,that is over the same term Guangxi GDP annual average growth rate of 14.53%,the annual average growth rate of malignancy indirect economic burden is 20.55%.The disease burden and economic burden of malignancy were heavy in Guangxi,the liver cancer,lung cancer,nasopharyngeal carcinoma were main malignancy in Guangxi,more effort should be pay attention to prevent and control of these malignancy.Section 3 Analysis on effect factor of economic burden of malignancy in GuangxiObjective: To analyze and explore the effect factor of malignancy hospitalization costs in Guangxi,in order to provide scientific basis to reduce the fast growth medical costs of malignancy.Methods: Base on hospitalization medical costs and relation data of malignancy 2013 in Guangxi,the total hospitalization expenditures and western medicine expenses were used as the dependent variable,and sex,age,payment types,type of medical institution,surgery or not,self-paying or not,malignancy types were used as the independent variable.Total hospitalization expenses,and western medicine expenses were divided into 4 order groups according to quartiles.Ordinal multiple categorical variable logistic regression model was used to analyze the data.Result:1.Total hospitalization costs of malignancy was relate to sex,age,payment types,surgery or not,self-paying or not,type of medical institution,and type of cancer.Female,children,over 60 years old,non-self paying,non-surgery,general hospital can increase total treatment costs.Compared with self-paying health care,the cost medical treatment for urban employee basic medical insurance and urban resident basic medical insurance was low,whereas,the medical cost for new rural cooperative medical system(NCMS)was higher.Compared with other malignancy,the medical cost for liver cancer,lung cancer,nasopharyngeal carcinoma,leukemia,stomach cancer,esophageal cancer,colorectal cancer,breast cancer,cervical cancer,ovarian cancer,brain and nervous system malignancies,pancreatic cancer,thyroid cancer and multiple myeloma were higher.Whereas,medical cost for the lips and oral cancer,bladder cancer,malignant melanoma skin,multiple myeloma,testicular malignancy were lower.2.Western medical coats was related to sex,age,payment types,surgery or not,self-paying or not,type of medical institution,malignancy types and so on.Female,children,over 60 years old,non-self paying,non-surgery,general hospital,can increase western medical costs.Compare with self-paying,new rural cooperative medical system(NCMS)could increase cost of western medical,and urban employee basic medical insurance could reduce western medical treatment cost.Compared with other malignancy,the western medicine cost for liver cancer,lung cancer,nasopharyngeal carcinoma,leukemia,stomach cancer,esophageal cancer,colorectal cancer,breast cancer,cervical cancer,ovarian cancer,pancreatic cancer,brain and nervous system,multiple myeloma,gallbladder and bile duct carcinoma,and hawking lymphoma were higher,and the lips and mouth,throat,other pharynx cancer,ovarian cancer,kidney cancer,bladder cancer,malignant melanoma skin,thyroid carcinoma,testicular malignancy,prostate cancer could decrease western medicine cost.Conclusion: The treatment cost and western medicine cost of malignancy were associated with a variety of factors in Guangxi and reducing the incidence of malignancy is the key,at the same time,to strengthen the management of NCMS and public medical care,reasonable medical and reasonable charge were needed. |
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