Study On The High Medical Expenditure And Influencing Factors Of Inpatient

ObjectThis study is to learn the current situation of the high medical expenditure and itsrelated factors, in order to be better able to rational allocation of medical resources,control the growth of high medical costs and establish a rational control mechanismsto provide basis for decision making for Medical and health institutions as well asmanagers.MethodsSelect the cases analyzed retrospectively, which single hospitalizationexpenditure was above100,000yuan form a3A hospital in Hunan Province duringthe period of2010to2012. All of the case was878. Select neurosurgery, neurologyand orthopedic staff interviews to understand the main causes of the high medicalexpenditure. Analyses were carried out descriptive analysis and using SPSS17.0software package. Statistical methods including Chi-square test, variance analysis andmultiple linear regression analysis. Disease classification uses the internationalclassification of diseases (ICD-10) standard.Results1. The general situation of the high medical expenditurePatients discharged from a total of239,658cases and the cases of the hospitalcosts of more than100,000yuan was878in2010-2012, representing0.37%of thetotal number of hospitalizations and its total costs accounted for7.77%of the totalamount of the entire cost of the discharged patients. For each of the high cost of the number of cases of the total hospital no difference in the proportion of the number ofdischarged patients (2=1.635, P=0.442). Shows each year is the high hospitalizationcases cost less but the high cost. Constituted from the cost point of view, the cases ofthe high cost of basic formation of high drug costs, the trend of the high cost ofmaterials, high cost of treatment.2. The related factors of the high medical expenditure(1) The high medical costs of the different number of days in hospital there aresignificant differences (P=0.000). The longer length of hospital stay, the higher thecost of medical. No significant difference in major medical expenses of patients ofdifferent ages (P=0.151). No significant difference in patients with high medical costsof the different gender (P=0.319).(2) The analysis results were showed the admission of patients, with or withoutrescue, infections, secondary surgery and treatment outcomes have a significantimpact on the high cost(P＜0.05). Patients with or without surgery and complicationsof the high cost of no significant effect(P＞0.05). Critically ill acute patients admittedto hospital medical expenses greater than the general condition of patients admitted tohospital (P=0.000). Rescue record the patient’s medical costs than patients withoutrescue record (P=0.004). Second surgery the patient’s medical expenses greater thanin patients with no secondary surgery (P=0.000). Infection in patients with medicalcosts than patients without infection (P=0.031). Deaths, medical costs than non-fatalcases of medical expenses (P=0.014).(3) Multivariate analysis results show that the impact of major medical expensesstatistically significant factors are age, length of stay, admission, secondary surgery,treatment outcome. With the order of the number of hospital days, admissions,secondary surgery, treatment outcome and age.(4) The high cost cases of disease distribution and departments relativelyconcentrated. The disease mainly Injury, poisoning and certain other consequences ofexternal causes, circulatory diseases and respiratory diseases. Different diseases thereis a significant difference in the high medical costs (P=0.000). The high cost cases aremainly distributed in neurosurgery, neurology and orthopedics. The different sections of the high medical costs were significantly different (P=0.000).Conclusion1. The results showed that the high cost of the small number of cases but the costis high. The cases of the high cost of basic formation of high drug costs, the trend ofthe high cost of materials, high cost of treatment. Medical expenses structure isirrational, the relatively low income reflects the technical content of the medical staff.2. High drug costs and the high cost of materials leads to high medical costs, theapplication of high technology also caused high medical costs. And the hospitalizationexpenditure is related to condition of patients. Medical expenses of the influencingfactors, the greatest impact is the number of days of hospitalization, followed byadmissions, secondary surgery, treatment outcome and age.3. To control health care costs, we must improve relevant systems, reduce drugsand materials, strengthen the management of the access and application of medicalhigh-tech. regulate Key influencing factors of medical expenses, establish a dedicatedcost spectrum to analyze, monitor the distribution of the relative concentration of thedisease and departments and control excessive service, the rational allocation ofmedical resources. Medical expenses are included in the performance assessment, andstrengthen the healthcare safety regulatory suppress the high cost of production alsohave a certain impact.