Analysis On The Factors Underlying The Costs Of Appendicitis At A 3A Hospital In Tianjin With Structural Equation Model

Objective:Based on the data about the expense constitution colloected from appendicitis patients in one of Tianjin 3A hospitals during hospitalization,their medical expenditures will be compared between different patients.The Structural Equation Modeling(SEM) will be used to analyze the factors influencing hospitalization costs and then its results will be compared with the ones from the traditional multiple linear regressions.In this way,the advantages and feasibility of SEM can be further elaborated so that it can be used on variuos aspacts such as a references on related research,the implementation of single disease policy of appendicitis in Tianjin,and also a guidance to improve the medical service efficiency as well as to reduce the burden of the patients.Methods:The all information of appendicitis patients were collected in one of Tianjin 3A hospitals from January 1st,2006 to January 1st,2008.Selecting and sorting the information of the hospitalized patients,the original model and the path diagram were established combined the professional knowledge according to the relationship between variables.The data ware analyzed by using professional statistical software LISREL8.70,and compared the results between with the traditional method's.Results:Drug cost took the highest proportion,more than 50%;the followings were the cost of treatment and materials.The costs of the above accounted for about 80%. The drug cost,treatment charges and materials costs of the patients with complications were more than without.The costs of inspection and operation of the patients with medical insurance were more than without,the drug and the treatment costs of the operation patients were more than the non-operation's,but the fixing costs were less than the non-operation's.By using SEM to analyze the impact factors of the costs of appendicitis,we divided the total fee into drug cost and treatment-related cost.It is showed that age has direct and indirect impact by the number of hospitalized days to drug and treatment-related costs,the direct path coefficient were 0.213 and 0.209,the indirect effectiveness were 0.129 and 0.154. The patients whether with medical insurance or having emergency treatment influenced the drug cost only,the effect coefficient were -0.105 and 0.200.Whether the patient suffered from complications influenced them through the hospitalized days respectively,the indirect effect coefficient were 0.078 and 0.093.The direct effects of hospitalized days to them were 0.564 and 0.674.However,we have no evidence to prove gender,marital status,whether or not to conducted non-essential inspection have impacts to them.Conclusion:By using SEM analyze the impact factors of 369 appendicitis patients' hospitalization costs in a 3A hospital,we not only found out the meaningful factors but also found out the direct and indirect factors from them respectively.At present, the structural equation modeling applications in the field of medicine is still rare.The use of SEM analysis in this study not only concluded almost the same conclusions which was also conducted by traditional multiple linear regression,but also provides richer information.It prompts that in the future research we can try to apply this method to deal with similar problems.At the same time,the conclusion can provide a certain valuable references to the government departments who formulates relevant policies of Medicare and to the medical service units who should strengthen their management,improving economic efficiency and reduce the burden on patients to achieve a multi-win-win situation in future.