Study On The Burden Of Direct Medical Expenses For Ostomized Patients In Shanghai

Objective This study used the medical insurance ostomized patients in a hospital in Shanghai as the research object,analyzed the direct medical expenses related to the stoma and its composition,and understood the relevant medical expenses burden level of Shanghai medical insurance patients.At the same time,combined with a small sample questionnaire to understand the quality of life and cost burden of ostomized patients.The study will propose recommendations for major cost burdens and patient needs,and provide a reference for the adjustment of relevant policies,thereby effectively reducing the burden of medical expenses for ostomized patients and improving their quality of life.Methods Through the outpatient registration system of Shanghai medical insurance ostomized patients,the research collected the information and medical records of ostomized patients from a hospitals in Shanghai from 2014 to 2017,and comprehensively reviewed the level of medical expenses related to stoma and its changing trends.At the same time,using the quality of life survey scale for ostomized patients,the quality of life of ostomized patients was evaluated from four dimensions: physical,psychological,spiritual and social.And in-depth investigations and interviews with the situation of stoma and the burden of stoma costs.Results(1)In this study,ostomized patients were mainly permanent stoma,accounting for 63.86%;the age was concentrated above 60 years;the ratio of male to female was about 2:1.(2)Ostomized patients are mainly treated in outpatient clinics,and the proportion of outpatient visits has increased year by year,all of which are above 98%.Temporary stoma patients have more visits per patient than permanent stoma patients.(3)The medical expenses related to stoma are increasing year by year.However,the proportion of medical insurance payments has decreased year by year.In 2017,the total cost of stoma-related medical care for 2,795 patients with stoma reached 11.03 million yuan.The patient's personal burden is heavier,and the average medical cost per person for the temporary stoma is higher than that of the permanent stoma.In 2017,the per capita medical expenses for temporary stoma patients was 26,900 yuan,and the per capita medical expenses for permanent stoma patients was 7500 yuan.(4)Gray correlation and structural change analysis showed that drug costs had the greatest impact on hospitalization costs,followed by surgery and other expenses.Surgery costs are a major factor in the increase in hospitalization costs.(5)From 2014 to 2017,the average outpatient cost and the average hospitalization cost of stoma patients showed a trend of volatility growth,with an average annual growth rate of 2.08% and 4.78%,respectively.(6)The cost of stoma supplies is increasing year by year and is a long-term cost.According to the questionnaire survey,71.26% of patients with ostomy have a monthly cost of purchasing more than 300 yuan for ostomy.It is suggested that in addition to hospitalization expenses,the burden of stoma consumables becomes the main burden for patients with stoma,especially for permanent stoma.(7)The quality of life of patients with stoma was at a general level(5.92±1.69 points),and it was affected by factors such as stoma type,serious complications,selfcare of patients with stoma,and participation in association(P<0.05).(8)The accessibility and convenience of stoma-related medical services need to be improved.It is mainly reflected in the lack of outlets for ostomy care services,the need to regulate the cost of ostomy care,and the inconvenience of the purchase of ostomy supplies.Conclusions(1)The burden of medical expenses for ostomized patients is heavier,and the existing level of medical insurance needs to be further improved.(2)Reducing the hospitalization expenses of ostomized patients should start mainly from drug costs and surgical expenses.The hospital itself must strictly regulate medical behavior and rational use of drugs.(3)The burden of medical expenses for patients with stoma is relatively heavy,and the cost of stoma supplies and stoma care is long-term.The current medical policy for stoma supplies may suppress the needs of patients with stoma to a certain extent,and should further improve the reimbursement policy for stoma supplies and increase compensation.(4)Patients with stoma are generally older and have limited mobility.It is necessary to improve the ostomy care service,improve the accessibility of ostomy products,and provide professional and accessible medical services for ostomy patients.(5)The study suggests that patients should be concerned with stoma patients,strengthen the teaching of ostomy care knowledge,improve the self-care ability of ostomy patients,and support the encouragement of hospitals,enterprises,and communities to carry out sorrow associations to help them better return to society.