Analysis On The Hospitalization Expenses Of Basic Medical Insurance In Hangzhou

BackgroundHangzhou, as one of the national medical insurance reform pilot areas, since its implementation of the basic medical insurance system for urban employees in the May2001,now has achieved the stage target that to full cover the population institutionally in insurance system. The health-care spending has dramatically risen from180million in2001to now nearly10billion Yuan. Since the growth of fund income has no more upside potential, the medical costs’ continuing increase will inevitably cause the difficulty of Medicare payments, and hamper the meeting of the insured people’s medical needs. So it is necessary to explore the main factors affecting the health-care cost and its growth and to provide reference for formulating and improving the relevant management system to supervise the reasonable growth of medical costs and the fund security. Hospitalization expenses are an important proportion of the whole medical expenses. Detailed analysis of the hospitalization expense will contribute a lot to the comprehension of the whole structure of medical cost. Since the medical expense structures are different from each other depending on the region and the medical security level, the present management of medical insurance which indiscriminately implemented in different medical institutions could not play the reasonable role in guiding and restricting the medical treatments in medical institutions and has been failed in effectively controlling the speedy increasing of medical care. The existing researches mostly take views from the population characteristics and the diseases classification.ObjectiveTo analysis the constitution and growth of the hospitalization expenses in different ranks of medical institutions in Hangzhou. MethodsCollect the hospitalization expenses information of several community hospitals, Level I hospitals, Level II hospitals and Level Ⅲ hospitals in Hangzhou from2006to2011which including western medicine expense, Chinese patent medicine expense, treatment expense, check expense, operation expense and so on. Calculate the structural change values and the structural change degrees of every kind of fees’ separately and analysis their variation tendency and contribution rates of structure change.Results1. For community hospitals, the total structural change degree of medical expenses from2006to2011is20.96%and the annual average structural change degree is4.19%. The structural change degree of medical expenses decreased from2006to2009, increased dramatically from2009to2011, and the maximum value is12.19%from2010to2011. For the total structural change from2006to2011, the contribution rate of Chinese patent medicine expense, western drug expense, beds expense and other expense rank among the top list, their total contribution rate is73.82%. The first three contribution rates for annually structural change are of Chinese patent medicine expense, western drug expense, beds expense from2006to2007, western drug expense, treatment expense and Chinese patent medicine expense from2007to2008,2008-2009,and2009-2010,Chinese patent medicine expense, test expense and beds expense from2010to2011respectively.2. For Level I hospitals, the total structural change degree of medical expenses from2006to2011is61%and the annual average structural change degree is12.2%. The structural change degree of medical expenses decreased from2006to2009, and the maximum value is40.71%from2010to2011. For the total structural change from2006to2011, the contribution rate of western drug expense, Chinese patent medicine expense, Chinese herbal drug expense and treatments expense rank among the top list, their total contribution rate is57.85%. The first three contribution rates for annually structural change are of treatments expense, Chinese patent medicine expense and operation expense from2006to2007, western drug expense, treatment expense and Chinese herbal medicine expense from2007to2008, western drug expense, treatments expense and test expense from2008to2009, treatments expense, western drug expense, Chinese herbal medicine expense from2009to2010, operation expense, western medicine expense and oxygen uptake expense from2010to2011respectively.3. For Level II hospitals, the total structural change degree of medical expenses from2006to2011is26.5%and the annual average structural change degree is5.3%. The structural change degree of medical expenses decreased from2006to2009, increased persistently from2009to2011, and the maximum value is31.98%from2007to2008. For the total structural change from2006to2011, the contribution rate of Chinese patent medicine expense, western drug expense, test expense and check expense rank among the top list, their total contribution rate is66.94%. The first three contribution rates for annually structural change are of western drug expense, treatments expense and Chinese patent medicine expense from2006to2007, western drug expense, treatment expense and operation expense from2007to2008, Chinese patent medicine expense, special treatments expense and treatments expense from2008to2009,Chinese patent medicine expense, western drug expense, treatments expense from2009to2010,treatments expense, western medicine expense and operation expense from2010to2011respectively.4. For Level III hospitals, the total structural change degree of medical expenses from2006to2011is14.93%and the annual average structural change degree is2.99%. The structural change degree of medical expenses decreased from2006to2009, increased persistently from2009to2011, and the maximum value is8.6%from 2010to2011. For the total structural change from2006to2011, the contribution rate of western drug expense, treatments expense, operation expense and other expense rank among the top list, their total contribution rate is76.21%. The first three contribution rates for annually structural change are of operation expense, test expense and special treatments expense from2006to2007, special check expense, test expense and Chinese patent medicine expense from2007to2008, treatments expense, Chinese patent medicine expense, test expense from2008to2009, western drug expense, treatments expense and operation expense from2009to2010,western medicine expense, Chinese patent medicine expense and treatments expense from2010to2011respectively.5. For the whole, the total structural change degree of medical expenses from2006to2011is14.21%and the annual average structural change degree is2.84%. The structural change degree of medical expenses decreased from2006to2009, increased persistently from2009to2011, and the maximum value is7.98%from2010to2011. For the total structural change from2006to2011, the contribution rate of western drug expense, treatments expense, operation expense and other expense rank among the top list, their total contribution rate is71.73%. The top list contribution rates for annually structural change are of other expense, beds expense and operation expense from2006to2007, special check expense and beds expense from2007to2008, treatments expense, other expense and Chinese patent medicine expense from2008to2009, treatments expense, western drug expense, Chinese patent medicine expense and operation expense from2009to2010, western medicine expense and treatments expense from2010to2011respectively.Conclusion1. In the hospitalization expense of community hospitals, the proportion of Chinese patent medicine expense has been declining yearly. Proportions of western medicine expense, beds expenses and other expense have increased slightly. Treatments expense, nurse expense and operation expense which embodying personal and technological values of medical staff account less in the total expense and have been less changed.2. In the hospitalization expense of Level I hospitals, proportions of western medicine expense and Chinese patent medicine expense have been declining yearly. The proportion of Chinese herbal medicine expense has increased persistently.3. In the hospitalization expense of Level II hospitals, proportions of Chinese patent medicine expense, transfuse expense, Consultation expense and nurse expense have been declining yearly. Proportions of western medicine expense, test expense, operation expense and Chinese herbal medicine expense have been increasing yearly.4. In the hospitalization expense of Level III hospitals, proportions of western medicine expense, transfuse expense, Consultation expense and nurse expense have been declining yearly. Proportions of Chinese herbal medicine expense and test expense have increased persistently.5. Totally speaking, the constitution and variation of hospitalization expenses of hospitals are different from each other depending on their level. Nevertheless, the medicine expense still share a lot of hospitalization expenses for all hospitals. Have increased slightly. Proportions of western medicine expense, transfuse expense, Consultation expense and nurse expense have been declining yearly. Proportions of treatments expense, operation expense and Chinese herbal medicine expense have increased persistently.