Analysis On Medical Expense And Its Construction Of Cerebral Infarction Inpatients Under New Rural Cooperative Medical System

Objective: This study selected Cerebral Infarction Patients under the New Rural Cooperative Medical System in nine counties of Anhui Province from 2012 to 2015. The hospitalization expenses data was acquired from Anhui Province New Rural Cooperative Medical System between January 2012 and October 2015 and was analyzed to explore the change trend and influencing factors of cerebral infarction patients’ hospitalization expenses and the economic burden of cerebral infarction patients. It would provide references to reduce the economic burden and control the rapid growth of medical expense.Method: Under the support of Anhui Province New Rural Cooperative Medical System management office, the database was established. Basing on the literature review and focus groups discussions, we established theoretical basis and formed the final research proposal. By the use of the descriptive statistics, the growth velocity analysis, gray correlation analysis and multiple linear stepwise regression analysis, the change trend and influencing factors of cerebral infarction patients’ hospitalization expenses and the economic burden of cerebral infarction patients was analyzed.Result:(1)The cerebral infarction were a total of 112418 cases, increased year by year with an aging trend,and the male patients was more than the female patients. The hospitalized patients in the north of Anhui Province accounted for 66.8%. The hospitalized patients paid fee according to medicine items accounting for 94.7%. More and more people chose the medical institutions in the township and county. From 2012 to 2015, the average hospitalization day was 11.9 days, which was on a declining curve. The operation ratio of cerebral infarction cases was 3.0%.(2) The average hospitalization expense and daily hospitalization cost of cerebral infarction cases was on the rise. The male patients’ average hospitalization expense and daily hospitalization cost were both lower than the female patients. However, the amount of increase of male patients was higher. Speaking from the age, the average cost and daily cost of the patients under the age of 45 was the highest, and the average cost increased most rapidly with a rate of 10.79%. The average cost and daily cost of the patients over 60 was the least and increased most slowly. Speaking from the area, the daily cost and the average cost of the north of Anhui Province were the highest, which was on a rise. The daily cost and the average cost of the medical institutions in the townships and county were obviously lower than others. The hospitalization cost of patients who paid fee according medical items was higher than the patients paid fee according to the DRGs. The average cost and daily cost of surgical patients were obviously higher.(3)The drug expense accounted for the largest proportion and the proportion of the treatment and examination was on the rise. The drug cost had the highest correalation with average cost while the surgical cost had the least correation.(4) The important factors of the hospitalization cost were respectively hospital category, hospitalization days, whether surgery, payment method, year, gender and region.(5) The average self-pay expense and the proportion the self-pay expense accounted for the average household income in Anhui Province decreased year by year.Conclusion:(1)The cerebral infarction cases increased year by year. For the aging trend of population, the daily care and prevention of the elderly should be strengthened and greater importance should be attached to the rural grass-roots staff’s training about cardio-cerebrovascular.(2) The hospitalization expense of cerebral infarction was on the rise and high expenses for medicine were a major factor. The pharmaceutical supervisory should be strengthened, the pharmaceuticals purchase by public bidding should be normalized and the compensation mechanism for medical institutions should be completed. Effective measures should be taken to control the unreasonable growth of drug cost and prevent hospitals relying too much on the drug income.(3) Hospital, hospitalization days, whether surgery, region, payment method, time and gender have different degrees of influence on the New Rural Cooperative Medical System cerebral infarction patients’ hospitalization expenses. The grading system should be established, the reasonable clinical pathway management should be promoted, the treatment process should be optimized, the payment method should be reformed and comprehensive measures should be taken to strengthen the control of hospitalization expenses.(4) The higher reimbursement ratio of the New Rural Cooperative Medical System reduced the economic burden of cerebral infarction patients. Besides the improvements of the compensation policy, the informatization supervision of the New Rural Cooperative Medical System should be strengthened. Through the establishment of reasonable incentive and punishment mechanism, the self-monitoring of hospitals should be promoted.