The Study On Hospitalization Expenses Of Patients With Coronary Heart Disease Under Diagnosis Related Group System In Anhui Province

Objective: To analyze the structure and influential factors of hospitalization cost of patients with coronary heart disease under Diagnosis Related Group System(DRGs),and then provide the decision-making basis for policymakers to improve the system.Methods: A total of 3365 patients with coronary heart disease were randomly selected from January 2009 to September 2015 through the Anhui Province Rural Cooperative Medical Management system,randomly extracted 3 counties in each of the counties.The trend and composition of hospitalization expenses were studied by descriptive statistical method and structural variance analysis method,the correlation analysis and rank sum test,multiple linear regression were used to analysis the external factors of hospitalization costs.Results: From 2012 to 2015,under the system of DRGs(1)The total number of hospitalized patients with coronary heart disease increased generally from 2012 to 2015,and the number of females was higher than that of men.Between the different regions in Anhui Province,the number of patients showed that the north of Anhui was higher than the medical area of Anhui,and the medical area was higher than the south of Anhui.(2)The cost of per inpatient of patients with coronary heart disease showed a decreasing trend,and the northern Anhui showed a declining trend,the southern Anhui region decreased year by year,the medical area of Anhui showed ascendant trend generally.In 2012,the cost of hospitalization in southern Anhui was the highest,reaching 9980.62 yuan,the lowest is the medical area of Anhui Province.From 2013 to 2015,central region in Anhui Province was significantly higher than that in northern Anhui and southern Anhui provinces.The average daily hospitalization expenses were not significantly changed.(3)The proportion of recurrent reimbursement expenses of patients with coronary heart disease showed an upward trend,and the proportion of the fee paid to the per capita income of Anhui residents in rural areas reduced,from 24.74% in 2012 to 4.50% in 2015.(4)The average daily hospitalization cost of patients with coronary heart disease under the project paid system was lower than that of the DRGs.In 2012 and in 2014,the average hospitalization fee of the patients with coronary heart disease under project paid system was lower than that of the DRGs.(5)material fee,laboratory fee,drug fee,bed fees lied in the front of the rate of structure variation,drug fee and materials fee were the main composition of the hospital costs.(6)Multiple stepwise regression analysis showed that the important factors influenced the hospitalization costs were hospital category,hospital days,whether surgery,region,year.Conclusion:(1)The the number of hospitalized patients with coronary heart disease under the DRGs increased in the overall,for the aging trend of population,the number of females was higher than that of men.We should pay attention to the health status of elderly patients with coronary heart disease and strengthen the popularization of coronary heart disease prevention and treatment,especially the prevention work for women with coronary heart disease.(2)Under the system of DRGs,the cost of hospitalization of coronary heart disease patients declined in the overall,the average daily hospitalization costs were not significantly changed,suggested that the number of the days of hospitalized patients with coronary heart disease had decreased,and the hospital treatment behavior had been standardized gradually,the payment reform inhibited the rise of medical expenses to a certain extent.(3)The proportion of patients expenses with coronary heart disease under the DRGs was decreased,the patient's medical burden reduced.(4)The average hospitalization costs and the average daily hospitalization costs of patients with coronary heart disease under the project paid system were lower than under the DRGs,payment system should be further improved,and still need a series of supporting measures.(5)From different regions,the numbers and the costs of coronary heart disease inpatients under DRGs had differences,suggested that the implementation and development of health policy need to focus on regional differences and promote balanced development within the region.(6)Drug fee and materials fee for patients with coronary heart disease costs under the DRGs were the main components and factors,suggested medical system should improve the cost structure,improve the proportion that reflect the proportion of personnel technical costs.(7)Treatment level,hospital days,whether surgery were the main factors to affect the hospitalization costs of patients with coronary heart disease under the DRGs,medical system should control the number of hospital days and strengthen the hospital own management.