Study On Expenditure Control Of Hernia Repair On Casemix Payment Reform In A Pilot Hospital In China

Objectives:By analyzing the expenditure structure and the influencing factors before and after the casemix payment reform in terms of the hernia repair in case hospital, this paper will discuss and analyze the variation of cost structure and the rationality. Evaluating the effectiveness and design of casemix payment reform in case hospital to improve the healthcare quality, improve work efficiency, control healthcare cost and reduce medical expenditure.Methods:We selected the discharge summary, daily list and urban and rural residents’ medical insurance management center’s data of all hernia repair cases in case hospital from August 1st 2010 to July 31st 2012. The data was processed with SPSS 19.0 and MS Excel. By using chi-square test, Mann-Whitney u test, Kruskal-Wallis h tests, interrupted time series analysis and multiple linear regression analysis to conduct systematic and detailed analysis, to discover the expenditure structure and influencing factors of hernia repair in case hospital.Results:(1) The basic condition of patients:A total of 250 patients were selected as study sample in this research, the majority of study population were male patient from 50 to 60 years old.97.69% of the patients were conducted spinal anesthesia.(2) The expenditure structure of hernia repair:The average expense was 4223.00 Yuan and 4421.26 Yuan before and after the casemix payment reform, the majority of hospitalization expense was medical consumables, surgical fees and drug fees, the percentage was 40.14%,22.24% and 17.41% after the reform, the proportion of drug was reduced 11.26%, however, the medical consumables proportion was increased 10.57%. Imported hernia patch occupied the highest proportion of medical consumables, the anti-infectious drugs were postoperatively and preoperatively used before and after the reform, the percentage was 64.34% and 54.05%. Cefazolin sodium, Ropivacaine and Hemocoagulase were the most common used drug in anti-infectious, anesthetics and hemostastics.(3) Analysis of average length for stay, average expense, actual reimbursement rate and average out-of-pocket indicators:The average length of stay was reduced 0.76days after the reform, the average expense increased 198.26Yuan, actual reimbursement rate has risen by 8.23%, and average out-of-pocket increased 153.51 Yuan. The statistical differences were appears in average length of stay, average expense and actual reimbursement rate before and after the reform, which was not appear in average expense and average out-of-pocket. The results of interrupted time series analysis is that casemix payment reform obvious affect the average length of stay and the actual reimbursement rate, the average monthly rise for 1.06%.(4) The influencing factors of the total hospitalization expense includes: Age, the usage of Ropivacaine, the usage of domestic hernia patch and casemix payment reform policy. The age is not controllable, however, the usage of Ropivacaine, the usage of domestic hernia patch and casemix payment reform policy are controllable.Conclusions:The effect of expenditure control of casemix payment reform is not obvious. The key to hernia repair medical expenditure control lies in the controlling of unreasonable actions on the medical supply side. The measures can be choice the suitable hernia patch, reasonable medicine usage and to strengthen the supervision on materials. Fully reflects the value of the medical staff services so to improve medical quality, and combines clinical path for payment reform thus reached both to control costs, but also can control the unreasonable cost objective.