Analysis And Evaluation Of The Influencing Factors Of Monopathic Medical Expenses On The Application Of Clinical Pathway Model

Objective:Five selected diseases were compared and analyzed in terms of medical expense structure,the cause of expense deviation,and the relationship among various causes before and after implementing clinical pathway in First People's Hospital of Yunnan Province.It was discussed of the impact on medical expense after implementing clinical pathway and hopeful to find solutions on health expenditure control,and to provide evidence based data for health bureau and insurance management in monopathy.Methods:237 inpatients of 5 selected diseases with the same standards of diagnosis,same therapy,enough sample size,and comparable features among groups were chosen in First People's Hospital of Yunnan Province between August 1,2009 to January 31,2010.The control study of patients with uterine fibroids,benign prostatic hyperplasia,gallbladder stone,nodular enlarged thyroid,natural childbirth were managed as a trial group under clinical pathway between August 1,2009 to February29,2010 and the patients with same diseases and comparable features were managed as a control group without clinical pathway between January 1,2009 to July 31,2010.The selected data includes patient name,gender,nationality,age,disease type,admission conditions,medical insurance coverage,length of stay,hospital charges,drug fees,examination fees,clinical treatment fees,operation fees,laboratory fees and disease condition change,etc.The comparing indicators were patient name, gender,nationality,age,disease types,admission conditions,medical insurance coverage,total hospital charges,drug fees,examination charges,treatment fees, operation fees,laboratory fees and disease outcome.It is evaluated for hospital costs, drugs fees,hospitalization cost,drug expense,examination fees,treatment fees, operation fees,laboratory fees,constituent ratio of the cost of total expense,were defined as the evaluating outcomes indexes.Numeration data were described as frequency and hypothesis test were performed with x~2 test or Fisher's exact probability;the measurement data were described as mean and standard deviation, and statistical inferences were conducted with T test or Non-parametric test.All statistical methods were performed with SPSS version 11.5 and the two-side significant test level was set up asα=0.05.Results:237 patients of 5 diseases as trial group under clinical pathway were randomly selected between August 1,2009 to February29,2010 and 249 patients with same diseases were put in the control group between January 1,2009 to July 31,2010. There is no statistically difference with gender,age,situation on admission,types of diseases,medical insurance coverage,recovery condition among groups (P＞0.05).Comparing to control group,the total expense of 3 diseases in trail group, such as uterine fibroids,nodular enlarged thyroid and natural childbirth decreased to different extend while the cost of hospitalization didn't decrease obviously.The total expense of nodular enlarged thyroid patients in trial group with clinical pathway were lower than that of the patients in control group(7820.6yuanVS8781.1yuan,P=0.00), the average total expense decrease 960.53 yuan.Benign prostatic hyperplasia, gallbladder stone in trial group were higher than the patients in control group.The total average expense in the benign prostatic hyperplasia group of the trial group was higher than that of control group(12806.6yuanVS11871.5yuan,P=0.03),with the average total expense increasing 960.53 yuan.The total average expense in the gallbladder stone group of the trial group was higher than that of control group (7900.6 yuanVS7441.4yuan,P=0.19),with the average total expense increasing 459.28 yuan.The average hospital days of 5 diseases were shorter than that of the patients in control group,the average hospital days of uterine fibroids(8.08VS.10.38,P=0.00). The average drug expenditure of natural childbirth,uterine fibroids,nodular enlarged thyroid patients in trial group was statistically difference from that of the patients in control group nodular enlarged thyriod(2201.1yuanVS3434.1yuan).and the examination expense of benign prostatic hyperplasia in trial group were higher than that in control group(952.9yuan vs 201.55yuan),there is no statistical difference of other factors among groups.The average treatment expense of uterine fibroids, nodular enlarged thyroid between groups had statistically difference,uterine fibroids decreased 124.6 yuan(p=0.003) nodular enlarged thyroid decreased 162.90 yuan(p=0.00) relatively.The average operation expense of 5 diseases did not-change obviously between two groups.The average drug expense and the average hospital days were the most important in the constituent ratio of the all expense.The average hospital days is the most important factor to affect hospital expense,it was also the most obvious effect of the factors to be controlled.The shorter length of stay,not only directly leads to reduced bed costs,but also results in savings of medical resources, resulting in lower hospital costs.Appropriate drug usage is the same critical issue as well as health care reform.The data from the research shows that it requires further regulation in drug usage when implementing clinical pathway.Conclusions:The results after implementing clinical pathway for five diseases Showed that the average medical cost can be reduced.It can also cut the average length of stay in controlled group.The average drug expense of natural childbirth,uterine fibroids, nodular enlarged thyroid patients were decreased with clinical pathways.While the cost of treatment of uterine fibroids,nodular enlarged thyroid patients were reduced. Clinical pathway has little effect on in reducing operation costs.It showed that the clinical pathway Plays an important role in the reduction of waste of medical resources and control the excessive growth of medical expenses.