Analysis Of Actual And Expected Inpatient-care Expenditures In Hefei

Objectives: The study aims at investigating patients?actual and expected Expenditures on inpatient care at hospitals in Hefei City, and developing approaches and strategies for improving the situation. Methods: Three hospitals of province, city and county level respectively were selected as study sites. Random sampling was used to draw inpatients and their relatives for gathering data. Data about expected expenditure was collected trough interviews. Data concerning expenditure actually occurred was derived by recording hospital bills after the patients under study had been discharged. Data entering, processing and statistic tests (u-test, variance analysis etc.) were performed using SPSS. Results: The study involved a total of 653 inpatients consisting of 340 (52.07%) male and 313 (47.93%) female. The number of patients selected from the province, city and county level hospital respectively was 256, 210 and 187. Of these patients, 312 (47.78%) came from county towns or larger cities and the remaining 341 (52.22%) , from townships or rural areas. Patients who were 60 years old or over accounted for 130 (19.9 1%). Main contributors to total hospitalization expenditure were drugs (49.47%), auxiliary examinations or tests (11.39%), treatment (15.69%), surgery (8.90%) and others (14.55%). The proportion of expenses on drugs and treatment to total expenditure in the three selected hospitals was almost the same. For inpatient care given by the provincial hospital, average expenditure for male is higher than that for female patients (u=3.66, P<0.0 1). Analysis of variance revealed that average expenditure varies for patients treated by different hospital departments (F=3.709, P<0.01). Pearson relationship analysis indicated that the patient抯 total hospitalization expenditure is related to expenditures on drugs, auxiliary examinations, treatment, surgery and others (P<0.0 1). For patients admitted to the city level hospital, expenditure of patients from city areas was found higher than that of patients from rural areas (u=3.18, NO.01). For admissions to the county level hospital, male patient抯 expenditure is a little bit higher than that of female patient, but the difference is of no statistical significance (u=0.095, P>0.05), and expenditure of patients from city areas was found higher than that of patients from rural areas (u=2.73, P<0.0 1). All the 653 2 00 ~ patients or their relatives were asked to compare actual with expected hospital expenditure. Reponses of higher than, equal to and lower than expectations accounted for 59.27%, 29.40% and 11.33% respectively. Conclusion: There are indications that hospitalization expenditure is too high and distribution of the expenditure is irrational. The key to coping with irrational increasing of cost on hospitalization is to containing drug cost increases. Specific approaches to this end include splitting clinical services from pharmaceutical service, standardizing prescribing behavior and increasing fees for clinical services. The study suggests that patient抯 gender, place of living and age etc. are all related to hospital expenditure. Each of these factors influences each other and makes more or less contributions to total hospital expenditure depending on specific situations.