A Research On Hospitalization Expense Composition Of The 3rd Stage Hypertensive Patients And Their Influencing Factors In A Grade AAA Hospital Of Kunming

Objectives:Through the investigation of Hospitalization Expenses of the 3rd stage hypertensive Inpatient cases in a Grade AAA Hospital of Kunming, Comparing the differences of hospitalization costs and composition between insured and uninsured inpatients; focusing on analysis of the influencing factors of hospitalization expenses and causes of rising medical expenses; exploring the development trend of Medicare payment methods, put forward reasonable proposals for the medical and health authorities and health insurers to develop DRGs criteria, provide new ideas for reform of medical payments.Methods:Using retrospective survey research method, we collected 1174 patients-medical record information from a grade AAA hospital in Kunming, patients were those who were diagnosed as the 3rd stage hypertension disease (according to the International Classification of Diseases, ICD-10) and discharged from hospital from January 1,2008 to December 31,2012; using SPSS 13.0 to all collected data by descriptive analysis, nonparametric rank sum test, chi-square test, Spearman rank correlation, multiple regression analysis and other statistical methods.Results:1. Hospitalization expense of the 3rd stage hypertensive patients showed a rising trend from 2008 to 2012, drugs costs is declining and the examination fee is on the rise in the five years.2. The Median hospitalization costs of Insured inpatients was 4837.31 yuan higher than those of uninsured inpatients(4742.50 yuan), the difference between they two groups is not statistically significant (P>0.05).3. Drugs and examination fees is a major component of the hospitalization costs, they two together accounted for more than 80% of hospitalization costs.4. The average length of stay of hypertensive patients was 10.7 days in China, the average length of stay was 10 days in public hospital in Yunnan province, the average length of stay in this research was 8.4 days, lower than the former two both.5. The main influencing factors of hospitalization expenses are:occupation, the length of stay, secondary diagnosis, past medical history, status of patients, type of nursing, whether do operation and payment types, the three main factors on hospitalization costs is the length of stay(0.474), nursing types (-0.248), whether do operation (-0.261).6. The main factors of hospitalization days were:occupation, secondary diagnosis, whether do operation, marital status and the hospital outcome.Conclusions:1. The proportion of drugs costs and inspection fees in the total costs of hospitalization is larger, to control unreasonable growth of hospitalization costs should focus on controlling the proportion of drugs and examination fees and improve the system of tiered medical service.2. Since the state of illness, physical condition and treatment plan of each patient was different, the costs of hospitalization is different, medical institutions should develop appropriate costs controlling measures according to the different characteristics and treatment plans of patients.3. Length of hospital stay, nursing level, whether the operation is the biggest impact on the cost of hospitalization of the three factorsHospitalization days is one of the most influential factors of hospitalization expenses.So shorten the hospitalization days, timely readjust the nursing level and reduce the operation rate is an important way to control the expenses of hospitalization.4. Payment standards of diseases were developed based on the first page of the medical record information. Therefore, to improve and enhance the construction of the hospital's information system,strengthening the standardized training of the medical record home page for clinical doctors,training of qualified medical staff, and improve the quality of the home page of the medical record information is particularly important.5. Strengthening the supervision and controlling of medicines, medical equipments and medical materials, and perfected the existing system of essential drugs, and improve the prices of diagnosis and treatment.