Analysis Of Hospitalization Expenses In The Insured Cirrhosis Patients Of Tianjin Based On The Method Of Structural Equation Model

Objective:To investigate the structure of hospitalization expenses of cirrhosis inpatients, the data of cirrhosis inpatients insured in Tianjin from2003to2007were analyzed, and the total medical expenditures, individual payments; pooling funds payments were compared between patients with different characteristics. The influencing factors of the hospitalization cost were analyzed with Multinomial linear regression and the Structural Equation Model (SEM), so as to explore the advantages and feasibility of SEM and provide the reference on related research. This study may offer the theoretic and practical evidence for establishing effective expense control mechanism and could propose some reference to use the medical insurance fund efficiently as well as alleviate economic burdens to the patients.Methods:2278qualified cirrhosis patients were collected form15%cases which selected randomly form medical insurance database within2003-2007of Tianjin residents. Descriptived the structure of hospitalization expenses and compared the medical expenditures between different patients with SPSS16.0, then analyzed the influencing factors of the individual payments and the pooling funds payments with multiple linear regression. Combined with professional knowledge, classified the influencing factors into socio-economic characteristic, hospital management features and clinical characteristics, then constructed initial path diagram and built a structural equation model using LISREL8.70.Results:Drug cost took the highest proportion of the hospitalization costs in cirrhosis patients, accounting for more than60%of the total cost; the followings were the cost of examination and treatment, the cost of the above accounted for more than80%. Length of stay, hospital level and the way of treatment were the main factors affecting the funds payment, the factors influencing individual payment were the same as funds payment, apart from the occupation. The expense of individual payment and funds payment was positively correlated with the number of days of hospitalization, the grade of the hospital the patient stayed and the ratio of operation fee. Individual payment in in-service staff was higher than that in retirees. Taking the hospitalization cost and length of stay as the dependent variable, used SEM to analyze the influencing factors of the medical expenses of cirrhosis patients. The results indicated that, age, gender and hospital level had direct impact on hospitalization expense with the direct path coefficient-0.05,-0.12and0.20respectively. Moreover, an indirect influence through the length of stay was also found with the indirect effectiveness-0.12,0.12and-0.08. The effect coefficient of the clinical characters and the length of stay was0.58and0.67. The path diagram showed that, except for the length of stay, the clinical characters of patients have the greatest impact on the hospitalization expenses. It prompts that relevant departments should take full account of the clinical characteristics of the patients when building case-mix for a certain disease, differences in payment standard should be attributed to the different clinical features.Conclusion:The study analyzed2278cases of hospitalization cost of medical insurance patients with cirrhosis, found out the structure of hospitalization expenses was unreasonable, the proportion of medicine cost was too high. By using SEM analyze the impact factors of the total cost, we not only found out the meaningful factors, but also found out the direct and indirect factors form them respectively. At present, the application of SEM is still rare in the field of medical expenses. The study use SEM analyze the hospitalization costs, model fits well, professional interpretation is reasonable, it prompts that we can try to apply this method to deal with similar problems in the future research. At the same time, government, hospitals and medical insurance institutions need work together to institute the charge criterion of specific entity based on common therapeutic standard, take full account of factors such as clinical diagnosis and treatment characteristics, hospital management features and demography characteristic when building case-mix for a certain disease. Effective measures, such as further regulating the length of stay and enhancing the surveillance of top-level hospitals, should be taken to control the excessive acceleration in medical cost, not only make sure the medical insurance pooling fund can be used efficiently, but also reduce the economic burden on patients in the future.