The Impact Of Medical Service Price Adjustment For Medical Cost In A Hospital

OBJECTIVE: To analyze influencing factors of hospitalization expenditures in the period before and after medical service price adjustment and find out the rules which provide the decision-making gist to health administration, health insurance institutions and the hospitals' managers for forecasting and controlling the inpatient's expenditures.METHODS: Using Excel software, this paper trussed a multi-dimensional data set with the statistical information of 26318 discharged patients' case records and expenditures details in a municipality general hospital in hunan province during 2005-2006. It also treated the data with single variable analysis through the multi dimensional views, as well as analysis of log-linear regression model.RESULTS: According to the discharged 26318 patient's data during 2005-2006 (male 52.8% female 47.2%) ,the average age is 38.61 and the average expenditures per time (AE/T) of the discharged patients is 3764.5 0 yuan, which in 2006 rose by 1.41 % compared to that in 2005. Overall length of stay is 10.88 days per admission. Expenditures for drugs constituted 34.91% of total hospitalization expenditures. Average expenditures per day is 345.97 yuan, which in 2006 rose by 24.99% compared to that in 2005. The distribution of expenditures isn't standard normal distribution, but log-normally distribution. Under single variable analysis, the complications such as gender, age, situation when entering the hospital, care effect, types of payment and disease, the length of stay have impact on the expenditures. There were 717 ICD-9 items in the study sample. As to the expenditures, the sum of the top 20 items occupied 33.78% of the hospitalization expenditures of the overall patients. As to the number of discharged patients, the sum of the top 20 items occupied 29.61 %. The log-linear regression model (logarithmic the length of stay and cost) had a highly tenability (R-2=0.628), the 21 variables selected in 25 independentvariables having great impact on the expenditures. -the length of stay inhospital ,operation ,age, salvage time entering for badly ill, entering for emergency, gender and results after therapy, adjustment of price. The operation had the greatest impact extent, the patients received operations spending 58% more than those non-operation patients in the same diathesis, then entering for badly ill (81.1%) , entering for emergency 16.1%,etc. The hospitalization expenditures of the patient who died in hospital is almost two times of that of the patient who recovered from disease after treatment. After analyzing the influencing factors of hospitalization expenditures in the period before and after medical service price adjustment, the top 7 influencing factors of both analysis include the length of stay in hospital, operation, age, salvage time entering for badly ill, situation when entering the hospital (emergency or danger).CONCLUSION: The price adjustment of medical service contributes to the rational changes of the hospitalization expenditures structure, and has changed medical service action of medical staff. It is able to control the unreasonably increase of hospitalization expenditures. The influence factors of the hospitalization expenditures are the basic same before and after medical service price adjustment, but the influencing intensity of each factor has changed.