Study On Hospital Delivery Expenditre And Its Determinants In Atertiary Teaching Hospital

BackgroundIn recent years,with socio-economic development and continuous progress in medical technology,medical care condition has improved significantly.Not only hospitalized delivery rate has a substantial increase,but also the rate of caesarean section has been rising.According to the results of three national health services survey,China's urban and rural residents' average hospital delivery rate has risen from 38.7%in 1993 to 50.4%in 1998 and to 68.3%in 2003,and caesarean section rate has risen from 2.4%in 1993 and to 6.1%in 1998 and to 15.9%in 2003.So the attendant increase in hospital delivery expenses has become a widespread concerned social issue.Hospital delivery expenses are directly related to the ability of pregnant women and their families to pay and affect whether health services can be effectively used at the producing time.Moreover,the results of national health services survey also show that the proportion of rural pregnant women not to accept the services for hospitalized delivery because of "economic difficulties" has been up from 14.84%in 1998 to 28.6%in 2003. Because parturition is a disease of clear diagnosis and relatively simple medical measures,and therefore hospital delivery is a fundamental but standard health service,this study use the data of hospital expenses of pregnant women in a teaching hospital to analyze its influencing factors,providing reference for effectively controlling the hospital expenses of pregnant women. ObjectiveStudy the composition of hospital expenses of pregnant women and its influencing factors by completely analyzing the hospital expenses of pregnant women in one first-rank teaching hospital in 2006,providing reference for hospital manager to use health resources more effectively for maximum health and social benefits and to control the excessive growth of medical expenses.MethodCensus method was used in this study to collect relevant data about all the cases and their hospitalized delivery expenses in one first-rank teaching hospital in 2006, and then analyzing the basic situation of hospital delivery,the hospital delivery expenses and its influencing factors.The data was analyzed by SPSS13.0.The statistical methods we use in this survey are descriptive analysis and multi-factor regression analysis.Main ResultsThe main results including:(1) the composition of hospitalized delivery expenses is closely related to the way of hospitalized delivery;the expenses of cesarean section is significantly higher than that of normal delivery;the proportion of drug expenses accounting for the overall cesarean section expenses is obviously larger than that accounting for normal delivery expenses;(2)hospitalized delivery expenses is also closely related to the request to hospital environment; hospitalized delivery expenses of pregnant women in high-price wards is higher than that of pregnant women in general wards;(3)hospitalized delivery expenses has a positive correlation with hospital days;the more hospital days they live,the higher hospitalized delivery expenses is;(4) hospitalized delivery expenses is related to whether has a gestation complication or not;(5) The multi-factor regression analysis reveals that there are many factors affecting hospitalized delivery expenses:such as drug expenses,hospital days,complications,ward level and so on.Conclusions(1) The average hospital expenses,the daily average hospital expenses and the average hospital days of normal delivery is lower than that of cesarean section;(2)Many factors affect hospitalized delivery expenses:the increase in the rate of cesarean section,inflation,high-tech application,the improvement of health care needs,inadequate payment mechanisms;(3)Drug expenses accounts for a large proportion;(4) the influencing factors of cesarean section includes: socio-economic development,scientific and cultural level,socio-psychological factors,legal policy,doctors and pregnant women's knowledge,attitude and behaviors and so on;(5) implementing safety evaluation on cesarean section technique,parturient women and the embryos;(6) diagnostic-related groups-based payment or price-control has effect on the rate of cesarean section.Suggestions(1) Reasonably controlling the rate of cesarean section;(2) During the days of pregnant women living in hospital,strengthening propaganda and education to enhance their confidence of normal delivery;(3)Taking effective measures to shorten the average hospital days;(4)Reducing the proportion of drug expenses accounting for hospitalized delivery expenses;(5) Strictly limiting the use of one-time items,reducing the price of medical equipment and disposable medical supplies;(6) Obstetric medical personnel strictly checking on operation indication;(7) Health Administration promulgating relevant policies and regulations to control the rate of cesarean section;(8) implementing diagnostic-related groups-based payment system or price-control system.