Study On In-patient Service Expenditures And Its Related Factors Of Patients With Acute Pancreatitis In Some Tertiary Comprehensive Hospital Of Sandong Province

BackgroundIn recent years,with the changes in people's eating habits and disease spectrum,the incidence of acute pancreatitis has increased.The cost of hospitalization for patients with acute pancreatitis is huge.On the one hand,individuals suffer from disease and bear a heavy psychological burden.On the other hand,the hospitalization costs are relatively high,which imposes a heavy burden on society and families.How to better control the unreasonable growth of medical expenses has become an important issue that needs to be solved urgently in the medical and health industry.It is of theoretical and practical significance to analyze the composition of hospitalization expenses for patients with acute pancreatitis and t(?)xplore its influencing factors.ObjectivesThis article uses the medical records of hospitalized patients with acute pancreatitis from January 2014 to December 2017 in a third-grade general hospital of Jinan City to analyze the basic conditions,hospitalization expenses and composition of hospitalized patients with acute pancreatitis,and analyze the hospitalization.The factors influencing the cost provide a policy basis for effectively reducing the economic burden of patients.MethodsBy using the method of retrospective investigation and analysis,the basic information of patients with acute pancreatitis diagnosed by digestive medicine department of a third-class general hospital in Jinan from January 2014 to December 2017.They are collected through the hospital medical record home page system,and the basic situation,hospitalization expenses and composition.The data collected were analyzed by SPSS24.0 software and Excel.The basic situation of patients and the constitution of hospitalization expenses were described by descriptive analysis.The influencing factors of hospitalization expenses were analyzed by non-parametric rank sum test and multivariate linear regression.To explore the influence of various factors on hospitalization expenses of patients with acute pancreatitis.Results1.Basic situation of patients with acute pancreatitisThe majority of hospitalized patients with acute pancreatitis were males,321 males(61%)and 205 females(39%).The average age of the patients was 49.86 +/-17.61 years,of which 224(42.6%)were under 45 years old,followed by 140(26.6%)patients aged 45 to 50 years old,and 223(42.4%)patients were in the municipal area of the hospital.There were 471(89.5%)patients,55(10.5%)patients of other types(including unmarried,divorced and widowed),and the average hospitalization days of patients with acute pancreatitis were 10 days.The main types of payment methods for hospitalized patients with acute pancreatitis are provincial medical insurance and employee medical insurance,with a total of 271 cases(51.6%),75 cases(14.3%),59 cases(11.2%),55 cases(10.5%),34 cases(6.5%),25 cases(4.8%)of provincial direct medical insurance,5 cases(1.0%)of three counties and one city,and 2 cases(0.4%)of other cases.Among 526 inpatients,211(40%)were admitted to emergency department,315(60%)were admitted to outpatient department,and 467(88.8%)were hospitalized once.2.Cost structure and changesAmong the individual costs,the highest per capita cost of Western medicine was 12986.6 yuan,followed by the laboratory fee,which was 2206 yuan per capita.In terms of the change trend of various expenses,the western medicine fee has a big change,showing an upward trend in 2014-2016,and a considerable decline in 2016-2017;the diagnosis and treatment fee,examination fee and treatment fee have an upward trend.3.Influencing factors of hospitalization expensesUnivariate analysis showed that there was no significant difference in hospitalization costs between sexes and admission routes for patients with acute pancreatitis.Age,residence,marital status,working status,payment method,concomitant diseases,diagnostic types,history of pancreatitis,complications,hospitalization days,western medicine expenses and other 11 factors were the influencing factors of hospitalization costs for patients with acute pancreatitis.Considering the interaction among the influencing factors,multiple linear regression was used to analyze the influencing factors of hospitalization expenses.Because hospitalization expenses do not obey the orthodox distribution,the natural logarithmic value of hospitalization expenses is used as dependent variable and 11 variables with statistical significance are used as independent variables.The main factors affecting the hospitalization expenses of patients with acute pancreatitis are:western medicine fee,hospitalization days,type of disease diagnosis,age,payment method,accompanying disease.Conclusion1.In the structure of hospitalization fees for patients with acute pancreatitis,the proportion of Western medicine fees in total hospitalization fees is too high,which fails to fully reflect the value of technical labor of medical staff.2.The western medicine expenditure which contributed the most to the change of hospitalization expenditure structure showed a negative change in the whole period of 2014-2017.The negative change range was larger in 2014-2016.The change range was relatively flat in 2016-2017,while the change trend of health materials fee,treatment fee and nursing fee showed a positive change in 2014-2016 and a negative change in 2016-2017.Since the implementation of the medical reform in 2016,the hospital has reduced the cost of Western medicine to a certain extent,and increased the labor value of medical staff to a certain extent,but the cost of Western medicine still dominates.3.The main factors affecting the hospitalization expenses of patients with acute pancreatitis are:western medicine fee,hospitalization days,type of disease diagnosis,age,payment method,accompanying disease;whether there are complications,urban and rural categories,marital status,history of acute pancreatitis,work The condition is also a factor in the cost of hospitalization.Suggestions1.Rational control of drug proportion.2.Reasonable examination,avoiding excessive auxiliary examination and testing,and reducing medical expenses.3.Improve the technical value of medical staff.4.Reasonable control of hospitalization days and reduction of hospitalization costs.5.Strengthen the construction of grass-roots medical service system,provide basic health services for residents,and reduce medical costs.6.Establish and improve the graded diagnosis and treatment model to reduce medical costs.