Analysis Of Hospitalization Expenses In The Insured Schizophrenia Patients Of Tianjin

Objective:To investigate the variation of the total cost and the expense of single items of hospitalization from insured Schizophrenic patients by splitting individual groups and to explore potential influencing factors. We try to create special groups with statistic models, and then filter abnormal cases on the basis of reasonable confidence intervals. So we hope that our study may do some help to the establish-ment of medical insure fees and policy and could propose some reference to suppress medical cost as well as alleviate economic burdens to the patients.Methods:At first, we propose a description of the cost in summary. Then new method of gray correlation analysis was adopted to make the quantitative analysis of the of the hospital fees. Value of structure variation(VSV), degree of structure variation(DSV), annual degree of structure variation and the contribution rate of DSV were used to analyze the structure variation of medical expenses for five years. Chi-Square Automatic Interaction Detection (CHAID) and Decision Tree were used to generate diagnosis related groups to designate confidence interval and validate the feasibility of this study path with single disease. At last, we use multivariable linear regression method to explore the potential factors influencing the total cost.Results:(1)In Tianjin, from2003to2007, the average cost of insured schizophrenic patients(x±s) is3014.59±745.31yuan. The mean of the per capita total cost were1986.94±538.79yuan,2181.92±503.85yuan,3861.22±738.29yuan in the first grade, second grade and third grade of hospital individually. In the whole cost, the fees of treatment, test fees, berth fees, drugs fees, other fees and material fee account for52.37%,22.60%,15.41%,5.04%,4.31%and0.27%respectively. In those5years the order of each single item was steady. The ratio of the average cost and average income of rural population showed a descending trend, so did the ratio of the average cost and average income of urban population. But this phenomenon got slowly after2005.(2) The rank of each portion of the hospitalization cost showed a steady tendency in the five years. As indicated by the method of grey correlation, the treatment expense was the largest part followed by test fees and berth cost. A relative steady tendency was found in the sequence of each portion of the hospitalization expenses for schizophrenic inpatients in these five years. DSV of the former two intervals were higher than the later two. The DSV of the hospitalization expenses from2003to2007was23.04%,5.76%per year. Treatment expenses, test cost and bed occupation are main items which contribute to expenses structure variation of inpatients and the cumulative contribution rate is77.91%.(3) The results of multi-regression analysis showed that the age, admission days, former admission times, grade of hospital, proportion of treatment fees, berth fees, material fees as well as others cost are correlated factors of hospitalization expenses(P<0.001). Positive correlations were found between age, admission days, grade of hospital, proportion of treatment fees, material fees and hospitalization expenses. And negative correlation were found between former admission times, berth fees, others fees and hospitalization expense.(4)21nodes were got from the3-depth decision tree with13final nodes. Grade of hospital, days and times of hospitalization were included to the tree structure, and there importance were0.7429,0.2442and0.0129. Age, gender and type of people were excluded which imply that their influence to the cost could be omit. We filtered1096abnormal cases accounting for about10.03%of the training sample. Their total cost was7165046.09yuan accountings for about21.60%of the whole cost. What’s more, their extra cost was1772930.7167yuan, accounting for24.74%of their total cost,5.34%of the whole cost。Conclusion:The per capita total cost took on a descending trend from2003to2007, indicating the effect of medical system reform in a degree. Prospective effect was got by the application of new gray correlation analysis and degree of structure variation. DRGs support us an effective analysis path in the study of organization and management to medical expense, so with the help of it we could explore more and more method in our medical service practice.