Study Of Influence Factors On Hospitalization Expenses Of Insured Patients Based On Recursive System Model

Objectives:to build recursive system models to describe the distribution of hospitalization expenses of insured patients and explore its influence factors., so as to provide decision reference for government, medical insurance institution, health administrative authority and hospital to enhance the management for medical expenses and service, to formulate feasible expense control policy and relieve the economic burden for patients, explore medical insurance polices fit our national conditionsMethods:collect valid information of case histories and hospitalization expenses for 20002 insured patients discharging from hospital during 2007 to 2009 from a polyclinic in shanxi province and set up database with Excel2007, using PASW Statistics and Amos 18.0 perform statistic description and single factor, multi-factor analysis.Results:there is 84.8% insured patients beyond 40 years old,76.1% for city-level Employees medical insurance,17.0% for province-level Employees medical insurance,4.2% for emeritus, 2.7% for city-level urban resident's medical insurance, and their mean hospitalization time is 15.6 days, mean hospitalization expenses is RMB 13611 yuan, their single item fee ranked in descending order as:medicine fee, checkup and assay expense, treatment fee, other fee, and daily room, among these, medicine expenses approaches to 50%, medicine, checkup and assay and other fee sum up to 82.1% from total, treatment fee only amounts to 16.1%. the first five diseases by person-time for discharging from hospital are:circulation system disease, tumor, digestive system disease, Musculo-skeletal and connective tissue disease, urogenital system disease; potential influence factors for total hospitalization expenses is hospitalization time, hospitalization time before surgery, age, other disease, not cured, eyes and appendage disease, surgery or not, rescue or not, gender, tumour or not, diagnosis time.Conclusions:the composition of hospitalization disease not only connected with prevalence rate of NCD and tumor, but also with professional level of subject in a hospital; the structure of hospitalization expenses of insured patients is not appropriate, that is the medicine and material expenses covered an unreasonable high proportion, but technical natured charge is relatively lower; self-pay proportion of insured patients is subject to insurance policy; it seems necessary to analyze hospitalization expenses with disease entity as a main character combined with relative factors; recursive model provide a useful tool for find the internal relationship among many variables; by exploring indirect effects of exogenous variables on hospitalization time, the complicated hierarchical relation between variables is revealed.