Analysis Of Hospitalization Expenses Structural Before And After New Medical Reform In A Tertiary Hospital Of Anhui Province

OBJECTIVES Analysis of hospitalization expenses and its constitution before and after new medical reforms in a tertiary hospital of Anhui Province.Explore the changing trend of hospitalization expenses in different ways,including: age,gender,and categories changes of medical insurance.Providing references for making and executing medical reform measures,improving of the control mechanisms of medical expenses,and further strengthening the efficiency managements of hospital.METHODSCollected the costs of 74935 discharged patients and integrated operating annual reports from a single hospital in Anhui Province from April 1,2014 to March 31,2015(before medical reform)and from April 1,2015 to March 31,2016(after medical reform),including the total costs of hospitalization and average hospital stays,per capita costs,the average daily costs and hospitalization costs of inpatients.The database was established by Excel 2007 software.Statistical analysis including two independent samples T test,nonparametric tests and Kruskal-Wallis rank sum tests were performed by SPSS 17.0 statistical software.RESULTS1.The average costs of hospitalization and average daily costs were higher after medical reforms.Total medical expenses were increased in different dimensions.The average costs of hospitalization had an increased of 4.12% and the average daily costs had an increased of 5.1%.2.The costs of medical reform were mainly consisted of the drugs costs,materials costs,surgeries costs,treatments costs,laboratories costs and radiation costs before and after medical reforms.The drug costs made up the highest proportion,the average costs and composition ratio of drugs declined the most,up to 6.72% and 4.11% respectively after medical reforms;The average costs and composition ratio of radiation costs fell up to 6.84% and 0.15% respectively;The average costs and composition ratios of medical,nursing,materials,laboratories,surgeries,beds,inspections and others had different degrees of rising,the highest composition ratio of costs was operating,up to 2.8%;the highest increase of average costs was the examination costs,up to 523.9%.3.The costs of hospitalization in different age groups had changed before and after medical reforms.In the composition ratios of total costs,the 60~<70 age group increased the most,reaching 0.68%,the 70~<80 age group decreased the most,reached 1.41%.In the average costs.In the average costs,a decreasing trend was found in the 0 ~ <20 two age groups,in which 0 ~ <10 age group had the largest decline,reaching 18.96%;a increasing trend was found in the 20 ~ <90 age group,in which 80 ~ <90 age group increased the most,Up to 7.92%?In the costs structure,medical costs and radiation costs decreased significantly after medical reforms.The medical costs in 0~<10 age group decreased the most,reaching 25.23%,radiation costs in 10~<20 age group decreased the most,up to 31.33%;The costs of surgeries,materials,inspections,nursing,and others costs were increased in all age groups,surgery costs and material costs in 80~<90 rose the highest,respectively reaching 46.23% and 32.68%.4.The costs of hospitalization for patients with different sexes had changed before and after medical reform.The total costs of hospitalization for men and women had an increased of 2.95% and 6.35% respectively compared with those before medical reform.In average costs,the drug costs and radiation costs in men and women fell most.The drug costs decreased by 5.5% and 8.28% respectively.The reduction rate of radiation costs was 7.07% and 6.43% respectively.The costs of surgeries,materials,laboratories,medicals,nursing treatments and others were increased in different degrees in both men and women,in which,examination costs rose the most,reaching 536.43% and 519.73% respectively.In the composition ratio of total costs,the drug costs in men and women decreased the most,up to 3.32% and 5.2% respectively.The composition ratio of costs of surgeries,laboratories,materials,medicals,nursing treatments and others were increased in different degrees in both men and women.The composition ratio of medical costs in men increased the highest,reaching 1.54%;The composition ratio of materials costs in women increased the highest,reaching 1.78%.5.Different types of medical insurance categories had different costs.From the view of total compositions,full costs of patients and new rural cooperative medical patients made up the largest proportion of patients after medical reform;From the view of average costs,all average costs increased,except the provincial medical insurance patients,the highest rate was railway medical insurance patients with a maximum amplitude of 24.21%.From the view of composition ratios of costs,the composition ratios of drugs and radiation costs in different categories of medical insurance had a downward trend,in which,the proportion of drugs of patients at their own expenses declined the most,up to 6.84%;The rate of radiation costs of railway medical insurance patients declined the largest,reaching 0.31%.From the view of average costs,drugs and radiation costs had a downward trend,drugs costs of provincial medical insurance patients decreased the most,up to 8.94%.Radiation costs in new rural cooperative medical patients declined the most,up to 7.81%.Others increased in different degrees,medicals costs increased the highest in all categories of medical insurance,surgeries costs of city residents health insurance patients increased the most,up to 45.51%;materials costs and drugs costs of railway medical insurance patients increased,reaching 39.64% and 26.12% respectively.The composition ratios of other expenses rose in different degrees.Surgical costs ratio of city residents health insurance patients grew the most,reaching 5.2%.Composition ratio rate of material costs of patients at their own expenses increased the most,up to 3.56%.CONCLUSIONAfter new medical reforms in public hospitals,medical expenses structure of inpatients changed greatly.The costs of drugs and radiations decreased largely,while the costs of surgeries,nursing,treatments,medicals,materials,laboratories and beds rose in different degrees,the medical costs structure was gradually optimized and the proportion of medical personnel labor service values became higher.However,controlling of the total costs of hospitalization was not enough,material costs,laboratory costs and other control costs increased largely.Hospitals should further deepen the medical reforms,explore and create hierarchical treatment systems,promote the reform of payment methods,and establish patient-centered fine management systems,so that to optimize the proportion of costs,t o control unreasonable costs and to efforts to reduce the hospitalization costs.