| Object Based on the analysis of variations and influencing factors of tuberculosis hospitalization expenses among patients in a Municipality of Guangxi,practical suggestions can be provided for reducing hospitalization expenses,reducing the financial burden of patients and their families,and achieving the goal of "no tuberculosis-affected person or family should face catastrophic costs due to tuberculosis care in 2020 and beyond" in WHO "End TB Strategy"..Methods Data comes from the medical records homepage of health direct reporting system,including the discharge date from January 1,2013 to December 31,2017 and the main diagnosis in consistent with TB coding(ICD-10 code including A15-A19,B90,B20.051,D86.251,J65.X01,098.001,P37.051,80.892-80.895)of hospitalized cases,excluding data with obvious errors and missing.8583 medical records were extracted for retrospectively analysis.New grey relational analysis method was used to quantitatively analyze the correlation degree between various hospitalization expenses and total hospitalization expenses,and the degree of structural variation analysis method was used to analyze the changes of each individual expense and total hospitalization expenses.SPSS25.0 statistical software was utilized to fit the path analysis model with the method of multiple linear regression analysis.The direct effect of each variable on the hospitalization expense and the effect of indirect influence of each variable on the hospitalization expense via the length of stay were calculated,and all of the influencing factors were ranked.The path diagram is drawn according to the analysis and calculation results.Results There were 6246 males and 2337 females included in the study.Among the age range of 0 to 95 years,the majority of patients are middle-aged and old,and case numbers of 41 to 60 years old and 61 to 80 years old patients are 2766 and 2706 respectively.7273 patients did not undergo surgery,which are in the majority.There were 6549 patients with complications.There were 6390 patients in secondary hospitals while 2193 patients in tertiary hospitals.The length of hospital stay was from 1 to 99.There were 3704 and 3630 patients with the length of hospital stay less than 10 days and between 11 to 20 days respectively.The most used medical payment is the new rural cooperative medical insurance,followed by full self-payment,which are 4095 cases and 2216 cases respectively.In terms of the composition ratio,the top three individual hospitalization expenses are western medicine expenses,diagnosis expenses and comprehensive service fee.The sum of their expense composition ratios is between 76.22%and 85.46%.Western medicine expenses(1.0000)showed the most correlative to the change of hospitalization expenses,followed by diagnosis expenses(0.8405)and comprehensive service fee(0.7751).The factors with the highest contribution rate to structural variations are western medicine expenses(26.04%),comprehensive service fees(23.58%),other expenses(21.65%)and diagnostic expenses(19.58%),with the cumulative contribution rate reaching 90.85%.In the past 5 years,the composition ratio of western medicine expenses and other expenses decreased,while the comprehensive service fee and diagnosis expenses increased.According to the results of path analysis,(1)the direct influencing factors of hospitalization days and their effects are as follows:surgery(0.172),hospital level(-0.157),complications or complications(0.074),medical insurance for urban employees(0.062),age(-0.056),and medical insurance for urban residents(0.037).All these factors can indirectly affect the hospitalization expenses via the length of stay.(2)The direct influencing factors of hospitalization expenses and their effects are as follows:hospitalization days(0.748),age(0.119),medical insurance for urban employees(-0.030),surgery(0.157),complications or complications(0.082),hospital level(0.202),and first visit(-0.019).(3)the influencing factors of hospitalization expenses and their total effect are as follows:length of stay(0.748),operation(0.286),complications or complications(0.137),hospital level(0.085),age(0.077),medical insurance for urban residents(0.028),first visit(-0.019),and medical insurance for urban employees(0.016).Conclusion western medicine expenses accounted for a greatest proportion(43.7%)in total hospitalization expenses,followed by diagnosis expenses(24.0%)and comprehensive service fee(13.3%).On the basis of controlling the hospitalization expenses,the internal structure of total hospitalization expenses should be adjusted and optimized to exhibit the labor value of medical workers.The path analysis results show that the hospital stay is the most important influencing factor on the hospitalization expenses.Keeping high quality of treatment,eliminating unnecessary hospitalization days,various strategies and measures should be comprehensive considered to reduce the hospitalization expenses. |
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