Study On Cerebral Infarction Hospitalization Expenditure And Its Influencing Factors In A Tertiary Teaching Hospital

BackgroundThere has been a general consensus all around the world to take actions and measures to control the rapid growth of medical costs, for the unreasonable increase of medical expenses has already become a worldwide problem and issue. In recent years, we witness the evident growth trend of the health care costs in our country and it is urgent to control the unreasonable growth of medical expenses. Hospitalization expenditure is the main part of medical expenses and it reflects not only the utilization of health resources but also the direct economic burden of patients, and experts and scholars at home and abroad have conducted in-depth study of it. Cerebral infarction is a common disease, commonly seen in the elderly aged45to70, with complex disease causes, a lot of complications, poorer prognosis and sequel, and it cause serious economic burden to the patients themselves, their family and the society. It will be helpful to understand the structure and the variation tendency, to find out the key influence factors, and will has great practical significance in taking pertinent measures to control hospitalization expenditure and control the unreasonable growth of medical expenses through analyzing the hospitalization expenditure of patients with cerebral infarction. In addition, in view of the current domestic focus on the cost control of single diseases, this study will also has important theoretical significance in providing some rational policy suggestions to control the costs and a reference for the establishment of policies and measures in managing single disease costs.ObjectiveThis research mainly studied cerebral infarction hospitalization expenditure in a Grade Ⅲ-A teaching hospital from2007to2011, analyzing its composition and variation tendency. The major objective was to find the key factors influencing the hospitalization expenditure by single factor analysis and multiple stepwise regression analysis, then to take appropriate measures to control hospitalization expenditure according to these factors, and also to provide the policy suggestion and reference for the establishment and improvement of single disease management and control system.MethodsA retrospective research method was used to collect the basic information through the hospital information system (HIS) and totally4669cerebral infarction patients who discharged from the hospital during the year2007-2011with the first diagnosis coded as163.902according to the method of the International Classification of Diseases (ICD-10) were selected. We not only analyzed the structure but also the influencing factors of cerebral infarction patients’ hospitalization expenditure. Excels were used to set up the databases and SPSS16.0package was used to do rank sum test and multiple stepwise regression.Main Results(1) In the past5years, cerebral infarction hospitalization expenditure presented a overall trend of increasing and the economic burden of disease became heavier;(2) It revealed that the structure of hospitalization expenditure was not reasonable and it was difficult to value the service and technique of medical workers. Medical fee, the average proportion as highly as53%, took the biggest proportion of the hospitalization expenditure; the proportion of examination fee and laboratory test expenses were also on the high side;(3) Length of stay was the most important factor influencing the hospitalization expenditure and the hospitalization expenditure continuously increased along with the prolonged hospital stay;(4) The analysis of single factor and multiple factors both revealed that gender, age, admission condition, rescue, accompanied disease, surgery and payment method all influenced the hospitalization expenditure;(5) To be specific, the average hospitalization expenditure of male patients was obviously higher than that of female patients; patients in high age group had a higher average hospitalization expenditure than that in low age groups; patients with a critical condition, a rescue, a accompanied disease, a surgery had a higher average hospitalization expenditure compared with patients who had a general condition, no rescue, no accompanied disease, no surgery; medical insurance patients had a lower hospitalization expenditure than the patients who were at their own expense and at free medical service.Conclusions and SuggestionsLength of stay had the most important influence on the hospitalization expenditure, so to shorten the average length of stay should be the breakthrough point to control the hospitalization expenditure; the high medical fee also influenced the hospitalization expenditure, much more attention should be paid to optimize its structure and properly control the proportion of medical fee; other suggestions include to perfect the health insurance system and adopt the reasonable payment methods; to strengthen the cost control consciousness and implement single disease management system; to establish scientific diagnosis and therapy standard and improve medical quality in combination with clinical pathway; to strengthen medical ethics and set up good images of medical industry; to strengthen the human-oriented service awareness and provide high quality services.