Analysis On The Influencing Factors Of Hospitalization Cost For The Insured Inpatients With Lung Cancer In Tianjin

Objective: The aim of this study was to understand the basic information of the insured patients with lung cancer and to demonstrate the internal structure and influencing factors of hospitalization cost for lung cancer patients in Tianjin from2003 to 2013.According to the results,this research was to provide the theoretical evidence and feasible strategies which aimed to hinder the excessive growth of the medical cost,thus to decrease the economic burden of patients suffering from lung cancer for health care reform in the future.Methods: A retrospective analysis was performed on the total 25 990 inpatients with lung cancer during January 2003 to December 2013 from the Tianjin Urban Employees' Basic Medical Insurance Register System database.50% cases of all subjects were randomly selected from the cases whose primary diagnosis were lung cancer(ICD-10 codes were C34?C34.1?C34.2?C34.3?C34.8 and C34.9).The cases whose days of hospitalization were less than one day and hospitalization cost exceeded SX ±3 were excluded.Through the Microsoft Office Excel 2007 software,the method of new grey relational analysis and the value of structure variation analysis were used to analyze the degree of correlation among each hospitalization cost and to evaluate the change of each hospitalization cost and their effect on the total cost in 11 years.R language 3.3.3 and SPSS Clementine 12.0 statistical software were utilized to fit the least absolute shrinkage and selection operator(LASSO)regression model and support vector machine(SVM),and thus to acquire the external factors of the hospitalization cost among patients with lung cancer.Results: A total of 25 990 lung cancer patients were included in this study,with 17501 males and 8 489 females.The patients were aged from 20 to 96 years old with the median 63.00(15.00)years old,5 268 cases of them were serving staff,20 646 were retired and 76 were old workers.The numbers of patients treated in the primary,secondary and tertiary hospitals were 69,2 304 and 23 617,respectively.Among all patients,10 817 cases underwent surgery and 15 173 cases did not.The days of hospitalization ranged from 1 to 90 with the median 13.00(12.00)days.Among the hospitalization cost in patients with lung cancer from 2003 to 2013,the medicine cost was most relevant to the hospitalization cost(1.0000),followed by the examination cost(0.7458),treatment cost(0.7094)and medical material cost(0.6923).The medicine cost contributed mostly to the DSV(42.76%)with a decreasing proportion of the hospitalization cost,which was followed by the examination cost(23.58%),Chinese traditional medicine cost(15.05%)and medical material cost(9.17%).The proportions of these last three items increased during 2003-2013.The accumulated contribution rate of these four items was up to 90.56%.LASSO regression analysis and SVM analysis showed that the number of hospital stays,blood transfusions,and surgery were influential factors of hospitalization cost for lung cancer patients.The cost of hospitalization for lung cancer patients with ? 8 days of hospitalization was more than that for hospitalization days < 8 days.The hospitalization cost for patients underwent surgical treatment was higher than that for patients without surgery.The hospitalization cost for lung cancer patients treated with blood transfusion during hospitalization was higher than that without blood transfusion.Meanwhile,LASSO regression indicated that in addition to the above three factors,hospital class,actual conceit ratio,gender,age,and category of people also affected the hospitalization cost of lung cancer patients.The cost of hospitalization for lung cancer patients attending a tertiary hospital was higher than that for patients attending a secondary hospital,and the hospitalization cost for patients attending a secondary hospital was higher than that for patients attending a primary hospital.The patients whose percentage of individual payment was 0.15 spent more money during hospitalization than those was0.05.The cost was lower for patients with the actual percentage of individual payment was 0.05 compared with those covered the cost by themselves.The hospitalization cost for female lung cancer patients was lower than the cost of hospitalization for male patients.Patients with lung cancer above 49 years old spend more on their hospitalization than patient aged ? 49 years.Comparing to the serving staff,the cost of hospitalization for old workers was higher.The importance analysis of SVM showed that the hospitalization days,blood transfusion,and surgery were the main influencing factors for the hospitalization cost of lung cancer patients,with the importance were 0.400,0.338 and 0.206,respectively.Conclusions: As the main internal factor affecting the hospitalization cost,medicine cost should be treated as a vital breakthrough to reduce hospitalization cost.The situation of "technology-based medicine" should be gradually formed by improving the value of physicians' technical services.In the meantime,relevant administrating departments should strengthen supervision of the examination cost and medical material cost in order to optimize the internal structure of hospitalization cost for lung cancer patients.LASSO regression analysis and SVM demonstrated that the length of hospitalization was the most important external influencing factor for hospitalization costs of lung cancer patients.Therefore,clinical pathways management should be implemented to shorten the number of days of inefficient hospitalization so as to reduce the hospitalization cost of lung cancer patients.