Study On Comparison Of Hospitalization Expenses Between The Insured And The Uninsured Inpatients And Expense Rationality Of The Insured In The Third Grade First-class Hospital

ObjectivesThrough statistical analysis of the data included hospitalization expenses between the insured and the uninsured inpatients from the third Grade first-class hospital, we understood the proportion and influencing factors of hospitalization costs in depth, simultaneously analyzed main causes of unreasonable growth of inpatient expenses, and then put forward measures to control the costs of insured inpatient. The study could provide a scientific basis for promoting effective use of health resources and implementation of local DRGs (Diagnosis Related Groups).Methods1. We combined qualitative methods with quantitative methods, literature search with special spot field investigation in the study, chose the only third Grade first-class hospital which is belong to appointed medical organization by local Social Security Department, we collected 14,005 valid data of included the first pages of all inpatients'medical records and their hospitalization costs in this hospital from August 2006 to August 2007, which used comparative analysis and multi-factor analysis on the quantitative data. At the same time, we gathered the interviewed information of stakeholders which used the subject-summarized analysis. All the data was set up a database of excel, and analyzed through SPSS12.0.2. To use normal t test or wilcoxon rank sum test on the comparisons of hospitalization proportion and costs between the insured and the uninsured inpatients; to useχ~2 test on the general situation of diseases between the insured and the uninsured inpatients; to use the non-parametric method of Mann-Whitney U test, Kruskal-Wallis test on the comparison of hospitalization costs and length of days between the insured and the uninsured inpatients with different sex, age, admission to hospital, the disease outcome, length of hospital stay, surgery or not ; while to use multiple linear regression analysis to analyze influence factors of hospitalization expenses and length of stay between the insured and the uninsured inpatients.Results1. At total cost of inpatients, median costs of hospitalization of the insured group ( 7412.70) are higher than those of the uninsured group (6186.04)(P<0.01).2. At the composition of hospitalization cost, the top four fees of the insured group and uninsured group are drug expenses, surgical fees, examinations and other costs (including health material expenses).3. In 15 kinds of diseases, the top three median costs of hospitalization are lung cancer, ureteral calculus and cerebral infarction, and the cost of the insured is higher than that of the uninsured inpatients.4. Through the interview, we knew that local Social Security Department strengthened supervision and management of medical insurance fund through implementing a services agreement with physician in 2006, that local Social Security Department signed an two-year agreement with doctors, as long as the doctor had a violation behavior, they would be deducted marks and punished. The physician would "pay" for the punishment at last. And the medical insurance fund expenditures decreased 30 million yuan from 2006 to 2007.Conclusions1. The implementation of medical insurance policy has played an active role in controlling of the hospitalization costs.2. To strengthen the control of drug expenses, health materials expenses, surgical operations, examinations.3. According to the characteristics of different groups and the influence factors of different diseases, the direction of the control measures should be reinforced so that the objectives of health policy can be achieved early.