Study On Hospitalization Expenses And Individual Burden Of The Insured Chronic Hepatitis B Inpatients In Tianjin

Objective:Analyze the internal structure and explore external influencing factors of the hospitalization expenses of chronic hepatitis B inpatients in Tianjin from2003to2007, aim to provide some valuable references for establishing reasonable costs control mechanism, and controlling unreasonable growth of medical expenses effectively. Investigate individual burden of the insured hepatitis B inpatients in hospital costs and its influencing factors, then using Monte Carlo simulation method to analyze how the door sill line, and reimbursement proportion influence the individual burden, in order to provide scientific references for adjusting reasonable reimbursement policy, so as to effectively reduce the individual burden of the inpatients.Methods:The method of gray correlation analysis was adopted to make a quantitative analysis of the internal structure of the hospitalization expenses. Then we use multivariable linear regression method to explore the potential factors influencing the total cost of the insured inpatients. By the structure change analysis, we wanted to analyze the structure variation of the mode of payment in the5years. Univariate and multivariate analysis were applied to analyze the influencing factors of the individual burden. At last, we use the Monte Carlo simulation method to study the individual burden in different hospital levels when door sill line, and reimbursement proportions were various.Results:(1) The average hospitalization expenses of insured chronic hepatitis B inpatients of Tianjin was11035.88RMB in2003. and increased to12541.24RMB in2007. As a whole, the average hospitalization expenses had a ascend trend. The proportion of drug fees was rising except in the year2005. And the proportion of examination costs was kept at around11.1%.(2)From2003to2007, in the hospitalization expenses of the insured chronic hepatitis B inpatients of Tianjin. the drug fees accounted for a large proportion, the average proportion was67.5%. And then examination costs, treatment costs and beds costs in sequence, their proportions were11.1%,7.6%,7.36%respectively. In2007, the proportion of drug fees was increased to70%, and the proportion of examination costs was12.1%, they accounted for82.1%of the total costs of hospitalization in total. The results of the grey correlation analysis also showed that, drug fees was the main influencing factor of hospitalization expenses, examination costs was the secondary factor, and treatment costs, bed fees were basic factors.(3)The results of stepwise multiple linear regression analysis showed that age, hospital stay, severity of illness, hospital levels, etc. were the factors influencing the hospitalization expenses (P<0.05), in which hospital stay had the greatest influence on hospitalization expenses. The older, the longer of hospital stays, the more severity of the disease, the hospitalization expenses were higher. The hospitalization expenses in tertiary-level hospitals were higher than in secondary-level hospitals. The hospitalization expenses in patients with complication were higher than patients without complications.(4) From the analysis of individual burden of the insured inpatients with hepatitis B in Tianjin from2003to2007, we found that individual costs of the insured inpatients with hepatitis B were rising. Individual self-paid ratio of them also increased from22%in2003to30%in2007. Structure change degree analysis showed that individual self-paid were positive changes from2003to2006, the individual self-paid ratio was rising. Only in the range of2006-2007individual self-paid was negative change, individual self-paid ratio went down a little bit. While fund payment and salvage payment appear a situation of opposite to each other.(5)The multivariate analysis of individual self-paid ratio shows that there were many factors influencing the individual self-paid ratio of the insured hepatitis B inpatients. On the one hand, factors such as hospital stay, severity of illness, affect individual self-paid ratio through the total hospitalization expenses indirectly. On the other hand, factors such as hospital levels, personnel sorts, affect the individual self-paid ratio directly.(6) The Monte Carlo simulation results:①Door sill line simulation:When the door sill line of tertiary hospitals various from1300RMB to1700RMB, the individual self-paid ratio was adjusted from31.29%to34.79%, it changed0.88%per hundred on average.②Reimbursement ratio simulation:When the reimbursement ratio was adjusted from75%to95%, individual self-paid ratio decreased from35.19%to18.05%, and the average rate of change was4.28%in secondary hospitals; in tertiary hospitals, individual self-paid ratio decreased from37.82%to21.31%, the average rate of change was4.13%.The results showed that reimbursement ratio had a greater impact on the individual self-paid ratio than the door sill line.③Combination simulation:Setting a2%of reimbursement ratio difference between different levels of hospitals, when the reimbursement ratios was adjustment from82%to88%, individual self-paid ratio reduced to26.99%from31.63%in tertiary hospitals. At this point, the difference was widened from4.06%to5.11%between the two levels of hospitals, which was significantly greater than1.12%when reimbursement ratio difference was not set.Conclusion:The average hospitalization expenses and drug costs of the insured chronic hepatitis B inpatients in Tianjin from2003to2007were on the rise. And the composition of the hospitalized costs was not reasonable. The proportion of the drug fees was too high, and it becomes the emphasis and difficulty in cost control. From the perspective of external factors, we found that the hospital stay, the severity of disease, age and complication were associated factors of the hospital costs. And hospital stays had the greatest effect in it. Therefore, shorten the hospital stays was the key to control drug costs and hospitalization expenses.The individual self-paid ratio of the insured chronic hepatitis B inpatients in Tianjin was controlled within30%.It reflected the security level of the medical insurance for urban workers to the insured inpatients. But at the same time, the data also showed that individual burden of the insured chronic hepatitis B inpatients in Tianjin was increased year by year. We must pay enough attention and vigilance to it.This study also found that the reimbursement ratios were the same in different levels of hospitals. The current health care policy had not played a very good role of leading the distribution of patients. When setting different reimbursement ratios between different levels of hospitals, the gap of individual self-paid ratios in different levels of hospitals was wider. So that it can lead patients to seek medical advice more reasonable, alleviate the pressure of the tertiary hospitals, and lightens the individual burden of patients.