Analysis On The Self-Payment Burden And Influencing Factors Of Medical Insurance Patients In Urban And Ruralresidents Of A Tertiary Hospital

Background:With the development of economy and the improvement of people's living standards,people's awareness of health care and the trend of aging have gradually increased,so the total medical expenditure in China is increasing year by year.The control of medical expenses is becoming more and more important to lighten people's burden.Since the merger of urban residents' medical insurance and new rural cooperative medical system were first completed in our province in 2015,Medical insurance patients of urban and rural residents in all basic medical insurance patients were the vast majority of them.Whether the medical security effect of these groups is good or not is related to people's livelihood.Understanding the operation of the basic medical insurance expenses of these groups and exploring the influencing factors of self-paid medical expenses became the key to guarantee and improve people's livelihood.Objective:By studying the operation status of hospitalization expenses and self-paid medical expenses of urban and rural residents' medical insurance patients from 2015 to 2017,was to understand the hospitalization expenses of urban and rural residents with medical insurance patients and the self-paid medical expenses.This paper would explore the influencing factors of residents' self-paid expenses,and put forward relevant policy suggestions for further controlling medical expenses and reducing the burden of patients.Methods:The research method was divided into qualitative research and quantitative research.The main qualitative research methods were policy research and literature research.Through these two research methods,we could understand the policy background of urban and rural residents' medical insurance and the research status at home and abroad;Quantitative analysis methods were mainly statistical analysis methods,mainly involving descriptive statistical analysis,non-parametric rank sum test,multiple linear regression analysis.This study collected demographic data,total hospitalization expenses,various constituent costs,self-paid medical expenses,self-paid proportion and overall payment expenses of urban and rural residents from 2015 to 2017 through His system of a third-class hospital in Shandong Province and geographic latitude system in Jinan City.Descriptive statistical analysis was used to analyze the basic situation of medical insurance patients in urban and rural areas,the composition of hospitalization expenses,self-paid expenses and overall payment.Non-parametric rank sum test was used to test the difference of self-paid expenses among patients of different gender,age,length of stay,personnel category,mode of medical insurance payment,region and year.Multiple linear regression analysis was used to compare the effects of various factors on self-payment.Result1.Composition analysis of hospitalization expenses:drug expenses,inspection expenses,examination expenses,treatment expenses,operation anesthesia expenses,medical consumables expenses and service facilities expenses accounted for 36.6%,9.22%,6.69%,8.06%,7.02%,26.59%and 3.78%of hospitalization expenses,respectively.The proportion of medicine was the highest,followed by consumables.2.Comparing with the basic medical insurance of urban workers,it was found that the self-payment and self-payment ratio of urban and rural residents' basic medical insurance was higher than that of urban workers' insured patients.In comparison with the general hospitalized patients,the self-paid medical expenses of the single-disease patients were higher than those of the ordinary hospitalized patients,and the self-paid proportion was lower than that of the ordinary hospitalized patients.Statistical analysis of self-paid expenses:In different demographic characteristics,including gender,age,length of stay,payment mode of medical insurance,operation department or disease type,the self-payment ratio of basic medical insurance for urban and rural residents was higher than that of national and world-recognized self-payment ratio.3.Analysis of Influencing Factors of Self-Payment Medical Expenses:In the analysis of single and multiple factors of self-paid medical expenses,there were significant differences in the influence of gender,age,length of stay,personnel category and payment method of medical insurance on hospitalization expenses(p<0.05).Among them,hospitalization days were the most important factor affecting hospitalization expenses.The influence of hospitalization days,age and year on hospitalization expenses was positively correlated.The hospitalization expenses of male patients were higher than those of female patients,and the hospitalization expenses of surgical departments were higher than those of non-surgical departments.Policy suggestionsThis study concluded that the proportion of self-paying medical expenses and self-paying for patients with basic medical insurance for urban and rural residents was higher.The proportion of medical insurance reimbursement,medical insurance fund financing,medical insurance policy changes,medical insurance payment methods,individual characteristics of insured patients,income levels,and hospitalization days were all influencing factors of self-paying medical expenses.Based on the results of this study,the following suggestions are put forward:1.Increase financial input,expand financing channels,and make full use of the power of social insurance,such as commercial insurance and charity assistance,to improve the overall payment level of basic medical insurance for urban and rural residents.2.The disease-based payment system is an internationally recognized method of medical insurance payment that can control medical expenses.The hospital should continue to strengthen the implementation of the disease-based(payment)fee system and the implementation of the clinical pathway.3.The hospitalization day is the most influential factor for the insured medical expenses of the inpatients of urban and rural residents' basic medical insurance.Comprehensive measures should be taken to shorten the hospitalization day,thus reducing the patient's self-paying medical expenses.4.Targeted "lock-in" target population,reduce the incidence of disease through interventions,delay the onset of disease,and achieve primary prevention and secondary prevention for key populations,thereby reducing the self-payment of this group of people.Medical expenses reduce the burden of medical treatment.