| ObjectivesWith the growth and aging population,the changing of life styles,cancer has become a threat to the health of human and the development of society.The increasing number of cancer patients means the growing health service demands and utilization.And it brings great economic burden to the society and patients' families.The study aims to describe the incidence and hospitalization service utilizations of four kinds of cancer patients from five counties in Shandong Province through the cancer registry files and the medical record information and hospitalization expense from the main county hospitals.And to explore the influence factors that affect the length of hospital days and hospitalization expense.Then to provide a reference to the formulation of cancer prevention and control strategies,the optimized allocation of health resources,the improvement of medical technology and the control of medical expenditure.MethodsFive counties were randomly selected as research regions in Shandong Province,according to whether cancer registration was carried out,geographic location,economic development level and so on.And collect cancer registration files of four cancers between 2011 and 2013 from the five counties,respectively,and then according to the files to collect the patients' medical record information and hospitalization expenses from the mainly county hospitals.The general information of hospitalized cancer patients and their hospital days and hospitalization expense were presented.Nonparametric rank tests were applied to univariate analysis of hospital days and hospitalization expense.The generalized linear model was applied to multivariate analysis after logarithmic transformation of hospital days and hospitalization expense on the basis of the univariate analysis.Data was entered into Microsoft Excel for sorting and proofreading,statistical analysis were conducted in SPSS 18.0.Results(1)The incidence rate of four cancers of five counties from high to low was lung cancer(63.89/105),stomach cancer(50.34/105),female breast cancer(37.40/105),intestinal cancer(22.10/105).And it showed a rising trend overall from 2011 to 2013.The incidence rate was higher among male except for breast cancer.The highest proportion of breast cancer patients was aging 45 to 59 years old,while others aging 60 to 74.The highest proportion of the clinical stage of lung cancer was phase IV,and the stomach and intestinal cancer was phase ? and ?;more than half of breast cancer patients diagnosed in phase ?.By the investigation,more than 70%of lung cancer patients had died,and it was the highest proportion of deaths of four cancer.The next was stomach cancer of which death proportion was more than 60%;intestinal cancer was about 40%and the lowest was breast cancer,about 18%.(2)The per capita hospitalization expense of all cancer hospitalized patients was 23575.4 yuan,and the per capita hospital days was 29.01 days;the highest per capita cost was intestinal cancer,was 25909.1 yuan.The per capita hospitalization expense of cancer hospitalized patients of Feicheng was 26248.46 yuan,and the out-of-pocket expense was 10162.84 yuan;the reimbursement ratio was 58.81%,the per capita hospital days was 37.84 days.The per capita hospitalization expense of breast cancer patients was the highest,was 33377.5 yuan.The per capita hospitalization expense of cancer hospitalized patients of Linqu was 22000.87 yuan,and the per capita hospital days was 22.31 days;the highest per capita cost was breast cancer,was 25968.18 yuan.The per capita hospitalization expense of cancer hospitalized patients of Rushan was 27630.02 yuan,and the per capita hospital days was 43.93 days;the highest per capita cost was intestinal cancer,was 28957.99 yuan.The per capita hospitalization expense of Wenshang was 12820.33 yuan,and the per capita hospital days was 18.27 days;the highest per capita cost was stomach cancer,was 15766.99 yuan.The per capita hospitalization expense of Muping was 23748.29 yuan,and the per capita hospital days was 23.80 days;the lowest per capita cost was lung cancer,was 20831.84 yuan.(3)The influence factors of hospital days:county,site,diagnosis time,'whether surgery','Whether chemotherapy','Whether radiotherapy' and clinical stage were the influence factors of hospital days of four kinds of cancer patients from five counties.The patient who was Rushan and Feicheng,breast cancer,diagnosed in 2012,surgical therapy,chemotherapy,radiotherapy and phase ? was with longer hospital days.The results of multiple-factor analysis of five counties,respectively,showed that 'whether surgery' were the common influence factors of hospital days,and surgical therapy patiets spent longer hospital days.'Whether chemotherapy' was the factor that affected Feicheng,Linqu,Rushan patients' days,and chemotherapy patients' days longer than no chemotherapy patients'.'Whether radiotherapy' affected Feicheng and Linqu patients' days.For Fecheng,Linqu and Muping patients,the younger the longer hospital days.Medical insurance influenced the Rushan patients' days,urban employee basic medical insurance and urban residents basic medical insurance patients' hospital days were longer than the new rural cooperative medical system patients'.(4)The influence factors of hospitalization expense:county,site,diagnosis time,'whether surgery',clinical stage,hospital days and age were the influence factors of hospitalization expense of four kinds of cancer patients from five counties.The patient who was Linqu,stomach and intestinal cancer,diagnosed in 2013,surgical therapy,longer hospital days,phase ? and ? cost more hospitalization expense.The results of multiple-factor analysis of five counties,respectively,showed that hospital days and'whether surgery' were the common influence factors of hospitalization expense of five counties.The longer days and surgical treatment patients,the higher the expense was.Cancer sites influenced Linqu,Rushan,Wenshang and Muping inpatients,hospitalization expense.'Whether chemotherapy' was the factor that affected Linqu,Wenshang patients' expense,and chemotherapy patients' expense higher than nochemotherapy patients'.'Whether radiotherapy' affected Feicheng patients'hospitalization expense.Diagnosis time influenced hospitalization expense of Feicheng and Rushan patients.For Muping patients,age also was the factor and the younger the higher.Clinical stage affected Rushan patients' expense,and phase ? and ? patients'higher.Medical insurance also influenced the Linqu patients' expense,urban employee basic medical insurance patients' hospitalization expense was higher than urban residents basic medical insurance and new rural cooperative medical system patients'.Conclusions and SuggestionsThe incidence rate of four cancer in rural areas in Shandong Province was higher,and the crude incidence rate of lung cancer and stomach cancer was higher than the national average.Besides breast cancer,incidence of male was higher than female.The average age of breast cancer was younger than other three cancer.Health education should be carried out actively,cancer prevention and control should be promoted to reduce or slow down the onset of cancer.More attention should be paid on the high incidence of cancer,screening and early detection and treatment should be conducted continuely.The coverage of population should be expanded and the diagnosis technology should be improved to achieve the purpose of early diagnosis and treatment.Hospitalization expense was the main part of the economic burden for cancer patients.Clinical pathway should be carried out and the diagnosis and treatment process should be standardized to improve the quality of medical care,shorten the hospital days and reduce the waste of medical resource to control the unreasonable medical cost and improve the health service and management level of hospitals.Meanwhile medical insurance system reform should be accelerated and the major disease security policies should be implemented to increase the reimbursement ratio and strengthen the supervision of the medical service process so that the medical insurance fund can play its role effectively. |
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