Current Situation Research Of Service Management And Medical Expenses Of Out-of-town Medical Insured Members In One Of The Top-three Hospitals In Shanghai

Objective:1. To realize the number and distribution of out-of-town hospitalized patients and the affecting factors of characteristic disciplines in hospitals by analyzing the hospitalized condition of out-of-town medical insured members in one of the top-three hospitals in Shanghai such as the proportion and medical expenses. To insight into the proportion and the affecting factors of hospitalization expenses by statistic analyzing the hospitalization expenses of cerebral hemorrhage and pituitary adenoma between Shanghai urban medical insured members and out-of-town medical insured members.2. To find out the contradiction in the management mode of the medical services in out-of-town and make policy suggestions to improve the mode by analyzing the hospitalized condition and questionnaire survey of out-of-town medical insured members.Methods:1. Making a random sample survey of out-of-town medical insured members in one of the top-three hospitals in Shanghai according to the questionnaire. Data established by Epidate3.O2 and the descriptive statistical analysis such as personal information, hospitalized information, personal expectation and satisfaction was executed by SPSS19.0 and Excel.2. Collecting the hospitalized history’s first page and hospitalization expenses of both Shanghai urban medical and out-of-town medical insured members of cerebral hemorrhage and pituitary adenoma who discharged from January 2012 to December 2012 in the top-three hospital by qualitative and quantitative research methods. Choosing 467 cerebral hemorrhage cases and 1208 pituitary adenoma cases as samples by sifting from 836 cerebral hemorrhage cases and 2601 pituitary adenoma.Data established by Excel and the statistical analysis by SPSS19.0. Using normal t-test to compare the hospitalization expense between Shanghai urban medical and out-of-town medical insured members of the two diseases and chi-square test to compare the categorical data and multiple linear regression analysis for the affecting factors of the hospitalization expense and the length of stay.Results:1. Out-of-town medical insured members account for 30% of the top-three hospital and still have a growing tendency. Especially in some national key disciplines, they account for nearly one half or more than half.2. Out-of-town medical insured members know little about the out-of-town medical insurance policy according to the questionnaire survey. It brings much trouble to the hospital to manage out-of-town medical insured members for the difference of the reimbursement range and the policy. Most of out-of-town medical insured members are satisfied with their hospitalized conditions in the top-three hospital such as the quality of medical care, humane environment, convenient facilities and service attitudes. While there are still some problems demanding prompt solution like expert outpatient services are hard to purchase and hospital beds take a long time to wait.3. According to the two diseases expenses analysis, the median hospitalization expenses of Shanghai urban medical insured pituitary adenoma patients is 38522.08 yuan in 2012 and 37693.24 yuan in 2013; the median hospitalization expenses of out-of-town medical insured pituitary adenoma patients is 36936.44 yuan in 2012 and 39187.25 yuan in 2013. The median hospitalization expenses of Shanghai urban medical insured cerebral hemorrhage patients is 31715.62 yuan between 2012 and 2013; the median hospitalization expenses of out-of-town medical insured cerebral hemorrhage patients is 24932.34 yuan between 2012 and 2013.The median hospitalization expenses of Shanghai urban medical insured pituitary adenoma patients is higher than that of out-of-town medical insured patients in 2012, while in 2013, the median hospitalization expenses of Shanghai urban medical insured pituitary adenoma patients is lower. The median hospitalization expenses of Shanghai urban medical insured cerebral hemorrhage patients is higher than that of out-of-town medical insured patients between 2012 and 2013. The two diseases are statistically significant between Shanghai urban medical insured members and out-of-town medical insured members (P<0.05). On the proportion of the expenses, there are significant differences in the medicine, operation and laboratory expenses between the two members according to the independent-samples T test; while the laboratory, bed and other expenses have no significant differences. The two diseases hospitalization expenses are influenced by the form of burden, length of stay and outcome of the patients.Conclusion and Recommendation:1. To suggest the hospitals to manage the out-of-town medical insured members according to the Shanghai urban workers basic medical insurance and establish standardized out-of-town medical management specification.2. To carry out the hospital collectivized management and implement patient transferring and distribution effectively.3. To set up network settlement platform for out-of-town medical insured members. To share the medical insurance information resources and raise the management efficiency and services level by taking the advantage of the network technology.4. To improve the reporting system and establish regular exchange visits institution.5. To regulate medical services and strengthen the construction of medical ethics.6. To develop medical technology assessment, establish clinical pathways and set up scientific standard of diagnosis and treatment.7. To shorten the useless length of stay, reduce the drug costs and control the growth of medical expenses.