Research On The Influencing Factors Of The Per-visit Inpatient Expenses Of County-level Public Hospitals In Anhui

Objectives By investigating the current situation and the per-visit inpatient expenses of county-level public hospitals in Anhui Province.We aimed to explore the impact of proportion of financial subsidies,medical costs,fixed assets,number of health technical personnel,proportion of personnel expenditures and so on and to find the factors that affect the per-visit inpatient expenses,so as to provide clues for reasonable control of medical expenses,reference basis and relevant countermeasures and suggestions,in order to achieve the purpose of reducing medical expenses.Methods Prior to the design of the questionnaire,Chinese and English literatures with the theme of "public hospital medical expenses" and "influencing factors" were searched through Chinese and English databases such as CNKI,CBM and Pub Med,and the influencing factors of medical expenses and control measures involved in the research at home and abroad are summarized,laying the foundation for the study.Through brainstorming,we invited experts from relevant departments such as the Price Bureau,the provincial health and family planning commission,and other relevant departments to discuss and publish opinions on medical expenses and their influencing factors and put forward their opinions on controlling the average hospitalization costs at county hospitals.The last combination of topics,we designed a comprehensively questionnaire that covered many aspects regarding to the inpatient expenses and its related factors.The questionnaires were sent to 136 county-level public hospitals of Anhui province with the help of administrative instructions.And we checked the suspicious data collected by telephone or on-site investigation and other means.In addition,we conducted personal in-depth interviews,insider interviews and on-site visits with the responsible officials of county-level public hospitals in Anhui Province in order to understand the existing problems and suggestions of the hospital itself.Finally 102 county-level public hospitals answered and provided complete data about the study.SPSS 16.0 was utilized to perform univariate and multivariate statistical analyses on factors that may influence per-visit inpatient expenses.Results The survey collected a total of 102 county-level public hospitals 2013-2015 complete data,of which 45 hospitals,57 general hospitals.The total cost of hospitalization,the total number of inpatient visits and the per-visit inpatient expenses of county-level public hospitals in 102 hospitals increased from 2013 to 2015.And the per-visit inpatient expenses of county-level public hospitals for Chinese medicine hospitals in 2015 increased more than that of 2014.In 2015,the inpatient expenses of102 county-level public hospitals in the province were about 4026.5±805.2 yuan.The highest per-visit inpatient expenses is 3.4 times the lowest per-visit inpatient expenses.The average per-visit inpatient expenses of individual hospitals were relatively high at more than 6,000 yuan.The number of their number of health technicians,fixed assets and medical costs were also relatively high.The average proportion of financial subsidies of 102 county-level hospitals was about 5%,while only 50% of the hospitals had financial subsidies of over 4.7%.The average proportion of the drug income accounting for the total hospital income was higher than 35%,there was even some proportion up to 55.6%.About half of the hospitals got the proportion of personnel expenditures accounting for the total hospital income less than 31.6%.Most hospital had no A inspection equipment and had one B inspection equipment.The factors influencing per-visit inpatient expenses of county-level public hospitals in Anhui province: The results showed that the per-visit inpatient expenses were not statistically different among groups by GDP levels(P=0.283)and among different proportion of drug income(P=0.474).There was statistically significant differences on the per-visit inpatient expenses among different proportion of financial subsidies(P=0.024).And there was also statistically significant differences on the per-visit inpatient expenses of proportion of personnel expenditures(P=0.035).The level of financial subsidies and the proportion of personnel expenditures had a negative correlated impact on the the per-visit inpatient expenses.There were significant differences on the per-visit inpatient expenses of the number of health technical personnel(P=0.000),the medical costs(P=0.001),the fixed assets(P=0.001),and the number of B inspection equipment(P=0.008).The number of health technical personnel was positively correlated,which meant the higher the number of health workers,the higher per-visit inpatient expenses,so as the medical costs,the fixed assets,and the number of B inspection equipment.Conclusions Controlling medical costs is a constant topic.And there are many factors that contribute to the increase in medical costs.This is a viable and effective strategy to find out the influence "external environment" factors so as to control inpatient expenses scientifically and reasonably through the annual per-visit inpatient expenses of county-level public hospitals as "charge control unit".The government and the public hospitals should increase the financial investment,strengthen the hospital management,especially the talent management,and improve the cooperation and communication of various and different departments,etc.,to reduce the inpatient expenses of county-level public hospitals to the maximum extent in a reasonable range,and finally achieve the public welfare of public hospitals.