Analysis On Influencing Factors Of Hospitalization Cost For Termination Of Early Pregnancy In A Grade A Hospital In Shandong Province

Objective: Through the research and analysis of the basic information,disease characteristics,treatment and hospitalization costs of patients who terminate early pregnancy in a third-class Class A hospital in Shandong Province,to explore the changing trend and key influencing factors of hospitalization costs,so as to provide a basis for reasonable clinical cost control and reference for medical insurance department to formulate payment standards for diseases.Methods: All the data related to hospitalization cost were collected from the Creating Medical Information System(CMIS),Hospital Information System(HIS)and Medical Insurance Geographic System of sample hospitals from January 1,2019 to July 31,2022,including the basic information of patients,disease characteristics and treatment,and hospitalization cost information.Excel2016 was used for sorting and assigning values,and SPSS23.0 was used for statistical analysis.The frequency and component ratio were used to describe the basic characteristics of the count data.The original data of hospitalization expenses and log-transformed data showed skewed distribution through S-W test,so the median(quartile)[M(P25,P75)] was used to describe the basic characteristics.Mann-Whitney U was used to test the differences in hospitalization costs of two independent samples,and Kruskal-Wallis H was used to test the differences in hospitalization costs of multiple independent samples.The X~2 test was used to analyze the distribution differences of variables in the groups of low,medium and high hospitalization expenses.The annual average growth rate and month-on-month growth rate were used to describe the changing trend of hospitalization costs.Grey relational degree was used to analyze the correlation degree between each item expenses and total hospitalization expenses.Multiple linear regression was used to analyze the main influencing factors of hospitalization expenses,and the statistical significance of partial regression coefficients of each variable was tested by self-help sampling,so as to further verify the accuracy and reliability of the results of multiple linear regression analysis.Results: A total of 1280 patients with termination of early pregnancy were included in this study.(1)Analysis results of basic information: In terms of age,the minimum age of patients was 14 years old,the maximum age was 48 years old,the median(quartile)[M(P25,P75)] was 32(28,37)years old,and the number of patients aged 26-34 years old was the largest,with 627 cases,accounting for 49.0%;In terms of marriage,married patients were the most,with 1131 cases,accounting for 88.4%;In terms of occupation,there were 709 patients without stable income,accounting for 55.4%,and 543 patients with stable income,accounting for 42.4%.Among the medical payment methods,460 patients were covered by basic medical insurance for urban employees,accounting for35.9%,431 patients were covered by basic medical insurance for urban and rural residents,accounting for 33.7%,and 389 patients were covered by full self-payment,accounting for 30.4%.Basic medical insurance for urban workers and basic medical insurance for urban and rural residents are social basic medical insurance,accounting for69.6% of the total.(2)Analysis results of disease characteristics and treatment: The median length of hospital stay(quartile)[M(P25,P75)] was 4(3,5)days,746 patients were hospitalized for3 ～ 4 days,accounting for the largest proportion of 58.3%,more than 70% of patients were hospitalized for less than 4 days;579 patients with gestational age > 7 weeks and <10 weeks,accounting for the largest proportion(45.2%);There were 660 patients with complications,accounting for 51.6%,and 620 patients without complications,accounting for 48.4%.There were 932 cases of pregnancy in the normal part of uterus,accounting for72.8%,and 348 cases of ectopic pregnancy in uterus(uterine scar,cervix,uterine horn),accounting for 27.2%.Among the types of abortion,missed abortion was the largest,with644 cases,accounting for 50.3%,followed by ectopic pregnancy abortion in utero,with348 cases,accounting for 27.2%.There were 1217 patients receiving surgical treatment,accounting for 95.1%,and 63 patients receiving non-surgical treatment,accounting for4.9%.There were 822 patients with 1 ～ 3 pregnancies,accounting for 64.2%,and 458 patients with 4 ～ 14 pregnancies,accounting for 35.8%.952 patients had 0-1 delivery,accounting for 74.4%,and 328 patients had 2-4 deliveries,accounting for 25.6%.There were 540 patients with 1 abortion,accounting for 42.2%,740 patients with ≥2 abortions,accounting for 57.8%,362 patients with ≥3 abortions,accounting for 28.3%;In terms of anesthesia methods,there were 993 cases of basic anesthesia,accounting for the largest proportion,77.6%;In terms of operation type,negative pressure suction or forceps curettage accounted for 1160 cases,accounting for 90.6%.(3)Analysis results of inpatient expenses: The total inpatient expenses showed a fluctuating downward trend,and the median(quartile)[M(P25,P75)] was 3551.90(3038.76,4214.90)yuan,with an average annual growth rate of-4.33%.Month-on-month growth rates were-0.39%,-12.80% and 0.81%,respectively.Among the sub-expenses,the cost of surgery/blood transfusion treatment and materials showed a continuous decreasing trend,with an average annual growth rate of-11.89% and-32.16%,respectively,and the sequential growth rate reached the lowest in 2020,with-27.23% and-58.20%,respectively.The diagnostic fee showed a trend of fluctuation decline,first rising and then declining,with an annual growth rate of-4.00%,and a month-on-month growth rate of 28.04%,-27.01% and-5.35%,respectively.The cost of non-surgical treatment,comprehensive medical service fee and drug fee fluctuated and increased.Among them,non-surgical treatment cost and comprehensive medical service fee increased first and then decreased,with an average annual growth rate of 26.81% and16.57%,respectively.The sequential growth rate will reach the highest in 2020,with162.15% and 61.71% respectively.Drug costs decreased first and then increased,with an average annual growth rate of 7.81%,and month-on-month growth rates of-0.63%,-4.23% and 31.69%,respectively,reaching the highest in 2022.(4)Results of grey correlation degree analysis: The degree of correlation between each item expense and total hospitalization expense from strong to weak is as follows:Diagnosis(0.9328),surgery/blood transfusion(0.9172),medicine(0.9041),comprehensive medical service(0.8608),non-surgical treatment(0.8015),materials(0.7253),and other expenses(0.5434).(5)Results of univariate analysis: Age,marriage,occupation,medical payment method,hospital stay days,gestational weeks,complications or not,abortion type,gestational site,operation or not,pregnancy time,delivery time,discharge year,anesthesia method,operation type and other variables had statistically significant differences(P < 0.05).(6)Results of multiple linear regression analysis: The factors related to hospitalization cost included the type of surgery,the method of anesthesia,the length of stay and the site of pregnancy.Among the surgical types,as opposed to medical abortion,Negative pressure aspiration or forceps curettage(β=979.415),negative pressure aspiration + transvaginal uterine scar repair(β=3135.404),negative pressure aspiration +laparoscopic(combined with transvaginal)uterine scar repair(β=10965.142)were positively correlated with hospital expenses(P < 0.001).Compared with no anesthesia,basic anesthesia(β=395.298),non-tracheal intubation general anesthesia(β=1978.360),intramural anesthesia(β=4427.637),tracheal intubation general anesthesia(β=7523.042)were positively correlated with hospitalization costs(P < 0.05).Hospitalization days(β=334.814)were positively correlated with hospitalization costs(P < 0.001).The more hospitalization days,the higher hospitalization costs;In pregnancy site,compared with normal site pregnancy,ectopic pregnancy in utero(β=745.934)was positively correlated with hospital expenses(P < 0.001).(7)Self-sampling test results: The 95% confidence interval for partial regression coefficients of variables related to hospitalization costs in the results of multiple linear regression analysis was: the 95% confidence interval for partial regression coefficients of negative pressure suction or forceps and curettage was(591.679,1325.859),(P < 0.05);The 95% confidence interval of partial regression coefficient of negative pressure aspiration + transvaginal uterine scar(resection)repair was(2252.091,4124.779)(P <0.05).The 95% confidence interval of partial regression coefficient of negative pressure aspiration plus laparoscopic(combined with transvaginal)hysterectomy and repair was(7855.659,14884.320)(P < 0.05).The 95% confidence interval of partial regression coefficient of basic anesthesia was(121.268,634.493),(P < 0.05).The 95% confidence interval of partial regression coefficient for general anesthesia without endotracheal intubation was(1312.727,2718.433)(P < 0.05).The 95% confidence interval of partial regression coefficient of intraspinal anesthesia was(3726.375,5265.152),(P < 0.05).The95% confidence interval of partial regression coefficient for general anesthesia with tracheal intubation was(6538.530,8451.257)(P < 0.05).The 95% confidence interval of partial regression coefficient was(265.450,416.720),(P < 0.05).The 95% confidence interval of partial regression coefficient of pregnancy site was(552.670,964.539),(P <0.05).The 95% confidence interval of partial regression coefficient of each variable does not contain 0,which indicates that these variables are meaningful variables,and also indicates that the results of the multiple linear regression analysis are accurate and meaningful.Conclusions: 1.Married women of childbearing age are the main population of hospitalized patients with termination of early pregnancy,and the key object of induced abortion education.Repeat abortion rate is higher,which conforms to current situation of abortion.2.The total inpatient expenses showed a fluctuating downward trend;The cost of surgery/blood transfusion treatment,materials and other expenses showed a continuous downward trend;The diagnostic cost fluctuated and decreased.The cost of non-surgical treatment,comprehensive medical service fee and drug fee fluctuated and increased.This indicates that the sample hospitals have made efforts in charge control in response to the call of the new medical reform.3.The correlation degree between each item of expenses and total hospitalization expenses from strong to weak is: diagnosis fee,operation/blood transfusion treatment fee,medicine fee,comprehensive medical service fee,non-surgical treatment fee,material fee,and other fees.The cost of diagnosis,operation/blood transfusion treatment and medicine are important aspects of cost control.4.The main influencing factors of hospitalization cost for termination of early pregnancy were: operation type,anesthesia method,length of stay and pregnancy site.The cost of hospitalization should be further reduced through reasonable selection of relatively low cost operation type and anesthesia method,scientific reduction of the length of stay and reduction of cesarean section rate.