| BackgroundChina is the country with the highest incidence of cancer and death in the world.Every year,cancer deaths account for one third of the world's cancer deaths.With the environmental pollution brought by economic development,the increasing aging,smoking,microbial infection,obesity and physical inactivity and other factors,the incidence of cancer in China is increasing year by year.Cancer not only brings great pain to patients,but also imposes a great disease burden on patients' families and society.ObjectiveThis study used data of Cancer Registry Report from the Jinan City in Shandong Province,medical records of inpatients at a top-three hospital in Jinan City,and inpatient and outpatient cost data to analyze the total treatment costs,hospitalization costs,outpatient expenses,and utilization of inpatient services of four kinds of cancer patients(intestinal cancer,lung cancer,breast cancer(female),and gastric cancer)diagnosed in a top-three hospital in Jinan City from 2011 to 2014.And we analyzed the influencing factors of total treatment costs and hospitalization days to provide a scientific basis.for controlling the excessive growth of medical expenses and the rational use of inpatient services.MethodsThis study selected the hospitalized patients diagnosed as having intestinal cancer,lung cancer,breast cancer(female),and lung cancer for the first time in a top-three hospital in Jinan City from 2011 to 2014.In this study,we obtain the general characteristics,medical payment methods and clinical stages of the four kinds of cancer patients from local cancer registration reports.Hospitalization service utilization,total treatment expense,inpatient expense and outpatient expense were obtained through inpatient medical record information and inpatient and outpatient insurance reimbursement information.Non-parametric tests were used for univariate analysis of treatment costs and days of hospitalization of the four kinds cancer patients.The generalized linear regression model was used for multivariate analysis of patients'total treatment costs and length of stay.The data was collated and proofread using EXCEL 2013 software.And SPSS 23.0 analysis software was used for statistical analysis.Results(1)In terms of age distribution,the minimum age of diagnosis for the four types of cancer patients was 24 years old,the maximum age of diagnosis was 91 years,and the average age of diagnosis was 61.62 years.The age of diagnosis was mainly concentrated in middle-aged people aged 45-59 and 60-70 years old.The young and old age groups accounted for 36.90%in each age group.In terms of the clinical stage,the highest proportion is the phase ?,which accounted for 32.10%,followed by stage ?,stage ?,and stage ?,accounting for 20.10%,19.20%,and 14%,respectively.In terms of treatment,72.80%of cancer patients received surgical treatment,and only 7.70%of patients received radiotherapy,and 46.70%of patients received chemotherapy.In terms of the hospital days,the minimum number of days of hospitalization was 1 day,the maximum number of days of hospitalization was 363 days.The average number of days of hospitalization was 75.10 days,and the average number of days of hospitalization for intestinal cancer,lung cancer,breast cancer(female),and gastric cancer was 62.64 days,80.64 days,92.45 days,and 62.65 days.(2)For male patients,the method of medical payment,whether or not to receive radiotherapy,whether or not to receive chemotherapy,the number of hospitalizations,and the number of inpatient institutions are the influencing factors for the length of stay in hospital.New rural cooperative medical insurance patients,other medical insurance patients,and patients who did not receive radiochemotherapy had fewer days of hospitalization.The number of hospitalizations,the number of inpatient institutions is proportional to the length of hospital stay.For female patients,the type of cancer,"whether or not chemotherapy",and the number of hospitalizations are factors that influence the number of days in hospital.Lung cancer patients,patients with radiotherapy and chemotherapy,have longer hospital stays,more hospital stays,and more hospital days.(3)The total per capita treatment costs,per capita hospitalization expenses,and per-patient outpatient expenses of the four kinds cancer patients were 105,887.53 yuan,1,000,038.71 yuan,and 12,881.75 yuan respectively.The total per capita treatment costs for colon cancer,lung cancer,breast cancer,and gastric cancer were 114,965.93 yuan,115,344.59 yuan,92,905.33 yuan,and 105,571.12 yuan.And the per capita hospitalization cost was 113,050.83 yuan,111,717.41 yuan,78,949.72 yuan,and 68,232.55 yuan.The per capita outpatient expenses were 5148.83 yuan,10881.55 yuan,18063.62 yuan and 7516.81 yuan respectively.The hospitalization expenses for the four cancer patients are mainly concentrated in the first year.The hospitalization expenses happened in the third year have a significant proportion of the total hospitalization expenses.With the exception of breast cancer,the hospitalization costs for the third year for the other three cancer patients exceeded hospitalization costs for the second year.From the perspective of reimbursement ratio,the reimbursement rate for urban employee insurance is the highest,exceeding 60%,The reimbursement rate for new rural cooperative patients is the lowest,only about 42%.(4)For male patients,the method of medical payment,"whether or not to receive surgery",and length of stay are factors that influence the total cost of treatment.New rural cooperative medical insurance patients and those without surgery have less total treatment costs;the more hospital days,the higher the total treatment cost.For female patients,clinical staging,number of hospitalizations,and days of hospitalization are statistically significant factors in the total cost of treatment.Compared with patients with stage IV,patients with stage I,stage II,and stage ? cancers have higher treatment costs.Patients with fewer than five hospitalizations have lower overall treatment costs than patients with more than 15 hospitalizations.The more days of hospitalization,the higher the total cost of treatment.Conclusions and SuggestionsThe age of diagnosis of the four kinds of cancer patients in this study was concentrated in the middle-aged and younger age old people groups,especially female breast cancer patients were younger than the other three cancer patients.At the same time,the clinical staging of the four kinds of cancer patients is mostly in the middle and late stages,and the proportion of early-stage patients is very low.This suggests that we should use cancer screening to screen cancer patients at high risk of age,so as to improve the rate of early diagnosis and early treatment of cancer.The economic burden of cancer patients is very heavy,and the medical expenses of inpatients are concentrated in the first year after diagnosis.The patient's treatment cost is affected by factors such as hospitalization days.Therefore,we can improve the quality of medical services and control cancer treatment costs.by implementing clinical pathway management,shortening the number of patients' unnecessary hospitalization days,deepening the reform of payment methods,advancing the implementation of the disease-based payment system,accelerating the reform of the medical insuance system,and increasing the reimbursement ratio of major illness insurance.Current research about the costs of cancer patients often analyzes only part of the patient's costs,which results in an underestimation of the cost of treatment for cancer patients.And the source of cost information for existing studies is not objective enough,leading to differences in the analyzed data and the actual situation..Therefore,in the future research,we can draw on the ideas of this study and improve it:By using the patient's insurance data,medical record data and reported data,we can achieve a more accurate and objective analysis of cancer patients'economic burden of disease and hospitalization services. |
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