| Objectives1. Based on a constant observation on the hospitalization status of the inpatients diagnosed with lung cancer, liver cancer, esophageal cancer and gastric cancer in a city in Gansu Province from 1996 to 2006, this paper analyzed the time trends of the cancer inpatients and their hospitalization costs according to the demographic characteristics.2. The regularity of the time trends in the direct burden of economy were showed by the estimated annual percentage change (EAPC) of the’mean’total costs and the constituent ratios of each internal item classified in accordance with its function.3. This paper also explored and analyzed the influencing factors of the direct burden of economy in details in order to closely analyze the ideal approaches to control the overwhelming economic burden on cancer patients. This paper would provide a reference frame for the government and related personnel in policy-making.Methods1. In order to gain access to full information about cancer inpatients and their costs. a retrospective record-type questionnaire (self-applied) survey among the medical records of all inpatients with the chosen malignancies was carried out. These diseases were diagnosed during the period from 1996 to 2006 in one provincial general hospital and one provincial specialty hospital, which were selected from the hospitals in the city by cluster sampling. The information in the questionnaire was typed into computer by special staff to establish a specialized database.2. To remove the effect of inflation on monetary value, we calculated the GDP deflator of each year during the observation period, according to Gansu Province index of GDP growth and actual GDP, selecting 1996 as the base year. So, the annual hospitalization expenditures were changed into a comparable variable.3. Firstly, this paper examined and compared the development of both geometric mean hospitalization costs per patient and geometric mean hospitalization costs per day among the selected diseases under study by using multiple spline curves plots, accordingly. Secondly, a curve estimation was executing based on the characteristics of scatter diagram and the fit was accessed then. Thirdly, the estimated annual percentage change (EAPC) was caculated to determine the changing speed. Finally, the effective rate for curing the four diseases was obtained to evaluate the rationality and scientificity of hospitalization costs soaring.4. The constituent ratios of each internal item classified into six categories in accordance with the function were analyzed to determine the relative size of each category of charge, from which the degrees of contribution of each charge were known and would help to explore the influncing facors from the internal of the hospitalization costs.Results1. Based on the inclusion criteria, we investigated 9,947 medical records altogether in which 9,772 were valid, including 3,115 lung cancer cases (31.88%),1,135 liver cancer cases (11.61%),1,743 esophageal cancer cases (17.84%), and 3,779 gastric cancer cases (38.67%). The ratio of valid questionnaire was 98.24%. From the results of investigation, we could know that the hospitalization of male was more than that of female and the age of onset of the diseases presented a trend of postponement, which suggested the government should pay more attention on the difficulty of medical service for the the low income staff and vulnerable groups. The average hospitalization days for conservative treatment were shorter and the daily costs lower than surgical treatment, but the effect was poorer than that of surgical treatment. The average hospitalization days in specialized hospital were shorter and the daily costs lower than general hospital, and the effect was better than that of general hospital. It suggested that the cost-benefit in specialized hospital was better than that in general hospital.2. Although the reform of health care system in our country was moving in a orderly way and the scope of medical insurance was enlarged gradually, the study suggested that the inpatients still faced a large economic burden due to low income.3. From the scatterplot and curve fitting, the geometric mean hospitalization costs per patient and geometric mean hospitalization costs per day for the selected diseases all had a linear relationship with the time and the equations of a straight line were valid (P<0.05) (except lung cancer). The coefficient of determination R2s of the fitted equations for the GHCs/P of liver cancer, esophageal cancer, and gastric cancer were 0.8423,0.9200 and 0.9388 respectively. The coefficients of determination R2s of the fitted equations for the GHCs/D of lung cancer, liver cancer, esophageal cancer, and gastric cancer respectively were 0.8198,0.9475,0.9807 and 0.9916.Judging from the R2s. we could know that the equations of a straight line reflected the true laws of changing with time of the direct economic burden incurred by cancer hospitalization.4. The Estimated Annual Percentage Change (EAPC) and its 95% confidence intervals (C.I.) of the both indicators were calculated to show the changing velocity of the economic burden. The EAPCs were all statistically significant (except the GHCs/P of lung cancer), which implied that the upward trends in the GHCs/P and the GHCs/D of select diseases were practically existent. The EAPCs indicated that the cancer economic burden raised fast, mostly at a speed of nearly or over the growth of GDP of our country.5. For the constituents of the costs, the drug costs occupied a largest percentage(40%-70%) and diagnostic procedures and therapies spending occupied the next(10%-15%). These items also experienced an increasing and there were no suggestions of stopping the development tendency. At the same time. ALOS had a steady decrease, could reflect the significant advances in early detection, clinical diagnosis and treatment of cancer.6. The results also indicated that the incresing of GHCs/D(8.64%-15.35%) was faster than the decline of ALOS(-5.59%--5.14%). Based on the relationship of "GHCs/D×ALOS=GHCs/P", the GHCs/P of the cancer inpatients finally exhibited a trend of increasing. Conclusions1. The difficulty and high cost of getting medical service was serious in female, low-income groups and patients at their own expense, especially for critical illness such as cancer. Consequently, they could not get medical service reasonablely and fairly. Therefore, the policy employed by the department concerned should be appropriately directed to these members of disadvantaged groups.2. The direct economic burden loaded on the inpatients with the four most common cancers in this city increased almost linearly and fastly with time. The patients had to face a large economic burden.3. The drug costs which was biggest in the six categories of charges made up a percentage ranged from 40%-70% of the whole direct costs for cancer care in hospital..which proved that the problem of "drug-maintaining-medicine" was still prominent in the present in China.4. Laying down a more rational therapeutic plan and selecting a suitable hospital to visit according as specific condition of the disease could improve efficacy of therapy and lower medical costs.5. To curb the irrational rise of medical cost based on shortening average length of stay only would be unsatisfactory. Lowering geometric mean hospitalization costs per day was also requisite to lower the total economic burden.6. The economic burden increased fastly, but the efficacy of therapy was not improved visibly, which underscored the urgent requirement for effective measures in lightening the financial burden of cancer patients. Such measures should be focused in future. |
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