| Objectives:After analyzing the components and influencing factors of hospitalization expenditure, this research is trying to seek the scientific and standardized administrative means to control the enhancement of inpatients' expenses, solve the problems of seeing a doctor expensively and difficultly, and provide the scientific basis for single disease quality control, development of medical security system and esophageal cancer prevention and treatment programs. To estimate the burden of disease by investigating data of esophageal cancer patients'direct non-medical cost and indirect cost.To study the satuation of esophageal cancer patients'life quality, and analyze the related effect factors.It can make a good push in raising the treatment's level of esophageal cancer and improve the patients'life quality.Methods:Based on the data of the hospitalization expenditure of 1776 esophageal cancer inpatients in the Heping general hospital of Changzhi, Shanxi province were analyzed by descriptive analysis and multivariate linear regression.216 cases were selected and investigated with the use of follow-up questionnaires and esophageal cancer EORTC Quality of Life Scale QLQ-C30, then gathered the indirect economic costs data and the life quality data of the postoperative patients. All the data were the quantitative data analyzed by SPSS15.0 statistical software. Retrospective survey method, descriptive analysis, one-way of variance, multivariate linear regression and Logistic regression methods were used.Result:1 Admission rate of esophageal cancer was increasing continually from 2002 to 2008, and the average hospital stay was increasing gradually, in 2002 for 16 days, by 2008 up to 20 days. The average hospitalization expenditure increased gradually too. The treatment fees, operation fees, cost of care were declining year after year, but Drug proportion has been stable at about 30%. The main influencing factors of hospitalization expenditure of esophageal cancer are as follows:hospital stay, drugs proportion, age, reatment consequence, surgical methods, health insurance. Hospitalization expenditure's growth caused by hospital stay, drugs proportion, age (P<0.01). Hospitalization expenditure's growth caused by these factors (P<0.01). Cost of esophageal lesions Resection is higher than the other surgical methods. Health insurance patients' hospitalization expenditure was higher than which of non-health insurance patients. (P<0.01). Hospitalization expenditure of cure consequence was more than the others (P<0.01)2 Different medical insurance system will have significant impact on medical costs, social health insurance, and a new rural medical cooperative system, the average medical cost up to 17,772.80 and 16,636.68 yuan respectively. It seems from the job classification, Heping hospital esophageal cancer patients with the overwhelming majority is for the peasants (1334 cases), accounting for about 76%. After Heping hospital becoming a new rural cooperative's designated hospitals, esophageal cancer treatment costs with a new rural cooperative medical insurance was rising rapidly and lower than the patients with social health insurance.3 The total cost of esophageal cancer patients consists of three parts:direct medical costs, direct non-medical costs, indirect costs, in the proportion of total costs accounted for 85.5% of direct medical costs, direct non-medical costs of 7.57%,6.93% indirect costs.The total economic burden of esophageal cancer patients has average of 26,697 yuan and a median of 24,338 yuan.4 The male esophageal cancer patients had higher scores than females in the assessment of physical function, emotional function, and cognitive function. There were significant difference in the gender among fatigue, pain, sleep appetite and other titles' scores (P<0.01). The scores of physical function, emotional function, cognitive function were significant difference in the different age groups (P<0.01). The elder patients group are more vulnerable in fatigue, pain, breathing difficulties and sleep disturbance than the younger groups (P<0.01).5 Gender, age, smoking, family income, education level were the significant impact factors affecting the quality of life of esophageal cancer patients. Gender was an important impact factor to physical function and insomnia symptoms. Age affected esophageal cancer patients' physical function, role function, emotional function, cognitive function and pain, breathing and insomnia symptoms. And physical function, the overall quality of life, loss of appetite, constipation and diarrhea affected by smoking. The family income may affect people's emotional function, social function and economic conditions. Education level affected cognitive function, nausea symptoms and economic conditions.Conclusion:The composition of esophageal cancer hospitalization costs and change trends had been learned by analyzing the esophageal cancer inpatients' information from 2002-2008. Appropriate measures and facilities will be used to control the hospital cost reasonably. This has a positive meaning to form a rational allocation and use medical resources effectively, as well as to make decision of government departments' health policy. Direct medical costs has the highest proportion; direct non-medical costs and indirect costs of associated has emerged accompanied by direct medical costs and both of those also increased the financial burden of the patient's family. Esophageal cancer patients of different age and gender status have the different quality of life. The dimensions scores of quality of life in esophageal cancer patients have been reduced. Gender, age, smoking, family income, education level were the significant impact factors affecting the quality of life of esophageal cancer patients. Health education, psychological counseling and behavioral therapy should be taken in order to improve the bad behavior and emotions, and facilitate the improvement the patients'life quality... |
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