Study On The Present Condition Of Hospitalization Expenses In Hangzhou

BackgroundThe reform and development of health care system is a topic of general interest whichhas aroused worldwide concem among statesmen, economists and hygienists. Wth thedeve1opment of advanced technology in medical field. more and more theraPeuticprocedures are available for the treatment of the same disease, bat the eXPenses varygreat1y At present, the ways of payment int6rnationally used inc1ude budget payment.prepaid on caPitation. Fee-for-service, Diagnostic Rel8ted Groupings. Each has itsadvantages and disadVantages as weIl. Considering the current situation of socio-economicsystem and culture in china, DiagnoStic Related GrouPings is a comparatively suitable wayof payment.The medical cost of a disease is the basis of working ollt reasonable compensationstandards, analyzing the quality of medical services, and calculating macroeconomic andmicroeconomic results. DRGs (Diagnosis ReIated Group System), invented chiefly byDob Fetter and John Thomson of Yale University at the end of l970s, has officially servedas the basis of PPS in medical insurance since Oct.l,,, 1983. According to differentdiseases grouped with ICD, DRGs is used to predict the standardized cost of a diseasebased on the patients' conditions and the therapeutic procedures during the hospitalization.Undergoing the continuous revision of nearIy twenty years, DRGs has proved to improvethe medical service system in the United States. It not only brings on the new reforms inhospital management, bllt also apparentIy shortens the average days of hospitalization(P<0.0 1 ).Following the United states, the Great Britain, France, Australia, Hungary andSingapore adopted DRGs one after another and revised and developed it in accordancewith nationaI conditions which achieves significant effect on controlling the irrationalrising of medical expenditllre. Diagnostic Related Groupings ptirsued abroad has graduallygained much attention of hospitaI administrators in our country and has been sttldies sincethe mid l980s. Up to now the theoretical research has developed from single sort ofdisease to disease mix program. This research used the main frame- work of DRGs forreference to explore and verity the feasibiIity of aPplying DRGs in Zhejiang proviflce.ObjcctivesBy analyzing the component of real hospita[ization expenses of five common diseasesin different 1eveIs of hospitaIs in Hangzhou, We studied the composing rate of thoseinfluencing factors and their different effects. The contro1ling standards for medicalexpenses of different diseases were reckoned which mny serve as the examples fOr themanagemeI'lt of medicaI cost and the reform of medical insurance.McthodsChoose five common diseases in the four deportments of interna1 1nedicine, surgery,gynecology and pediatrics. The five diseases are typical among in --patients (On conditionthat the diagnosis of the disease is definite; the tfeatment is effective, it is easy to analyze.The diagnostic standards consult ICD-9). The five diseases are internal medicine-coronarydisease, surgery-appendicitis, gynecology and obstchicsinatural parturition and caesareanbirth, p edi atfics-bronchopneumon ia. C ondllC que sti onnaire survey (med ic aI re cord fi leand financial record) and retrospective survey on existihg situation among the in-patient ofprovince, city, and distfict-level hospitals in Hangzhou from l997 to l999 Who sufferedfrom the target diseases.The material was selected (crossing out the patiellts with incomplete basic items),corrected and supplied with missing information after it had been co11ected. By usingSPSS for windows l0.0, the data was pllt iflto complJters and was sorted out, put in order,corrected logically and anaIyzed with descriptive & muItiple stepwise regression analysis.By the analysis of the average hospitalization expense, study its composing rate and probeinto the innuence of hospital grading, differeni depcheni, patients' socio-economicaI...