Study On Influential Factors,Composition And Payments Standard Of Hospitalization Costs In Affiliated Hospitals Of Military Medical University

Objective: Investigating influence factors,abnormal composition and payment standard of hospitalization costs to provide basis to control unreasonable increase of medical costs and improve the rate of rational use of medical resources.Methods: Five representative diseases: coronary heart disease,appendicitis,vaginal delivery,Caesarean delivery,chronic hepatitis B and 7713 patients suffered these five disease in three affiliated hospitals of military medical university between 2003 and 2006 were enrolled in this study with the standard of three characteristics:clear diagnosis (according to ICD-10),obvious curative effect,easy analysis.Rank sum test, multiple linear regression analysis was applied to find out influence factors and abnormal composition of hospitalization costs of the five representative diseases. Then, case mix was used to establish the payments standard of the five diseases. Results: (1)The ratio of drug cost to whole hospitalization costs is in great proportion but the ratio of technical projects charge in too low in all five disease especially in coronary heart disease and chronic hepatitis B,which are two main obstacles for us to construct a rational composition of hospitalization. (2)The rank sum test showed that hospitalization days, mode of payment, disease condition and diagnosis and treatment outcome are correlative factors of inpatient costs. (3)Result from multiple regression liner analysis revealed that hospitalization days is the most important influential factor for inpatient costs. (4)The payments standard of the five diseases was established successfully through the method of case mix.Conclusions: We can control unreasonable increase of medical costs and improve the rate of rational use of medical resources by the following ways(1) Reducing the drug cost and improve technical projects charge appropriately.(2) Shortening non value adding patient days, improving medical treatment quality and reducing the daily average hospitalization costs are three effective ways for our purpose. (3) Establishing the payment standard of disease by case mix and DRGs to guide the payment of hospitalization costs. (4)Reforming the way of payment and establishing the standard of diagnosis and treatment to guide the payment and treatment of inpatient patients.