Research On The Situation Of Current Health Expenditure And The Impact Factors Of Hospitalization Expenditure In Gansu Province

Objective: Scientific and effective decision-making on health requires reliable and stable data support.Based on “A System Of Health Account 2011”,this study analyzed distribution of current health expenditure in Gansu Province in 2016 and explored the influencing factors of inpatient expenditure through recursive system models and path analysis method in this study to provide data support for Gansu Province in formulating and adjusting health policy,and provide scientific evidence for optimizing health financing structure,realizing the rational allocation of health resources,and reducing the burden of health expenditure for government,society and residents.Method: Based on the accounting framework of A System Of Health Account 2011”and according to a top-down approach,using the data from official statistics such as Health Financial Report of Gansu Province,Health Statistical Report of Gansu Province,and on-site investigations of 15 counties(districts)in tianshui such as Zhangye,Pingliang,Dingxi and Wuwei,current health expenditure in GanSu province was analyzed in three core dimensions,three extended dimensions,and a cross-analysis in core dimensions and extended dimensions.All the data are summarized in EXCEL2013,and the cross-processing of each dimension is performed in the STATA12.0 software.Secondly,based on the data from on-site survey,method of descriptive analysis,single factor analysis,recursive system model and path analysis were used to explore the influencing factors of hospitalization expenses in Gansu Province.Descriptive analysis,single factor analysis,recursive system model analysis were constructed in SPSS22.0.Path diagramwas performed in AMOS22.0 software.Results: 1.The current health expenditure amounted to 55.14 billion yuan in Gansu province in 2016,and per capita health expenditure was 2112.49 yuan.From the perspective of financing schemes,current health expenditure was dominated by public financing schemes with a share of 59.85%,and household out-of-pocket payment took up 37.03% of the total.From the perspective of health care providers,it aggregated 34.28 billion yuan in hospitals,comprising 62.17% of current health expenditure.Primary health care institutions reached 10.48%.From the perspective of health care functions,curative care expenditure accounted for 77.40% and preventive care expenditure accounted for 6.20%.2.The curative expenditure of male was 20.96 billion,and female was 21.697 billion,with the proportion of 50.86% and 49.13% respectively.The per capita expenditure was higher for women than for men;The five age groups with higher current health expenditure were 50-54,45-49,60-64,65-69 and 40-44 age group,and the expenditure were 5.081 billion,4.667 billion,4.147 billion,3.431 billion and 3.146 billion respectively.The per capita expenditure in 70-74 age group was the highest.The expenditure for non-communicable diseases was as high as 27.251 billion yuan,accounting for 63.58% in the GBD disease classification.Diseases of circulatory system,respiratory system,digestive system,tumors and injuries caused a heavy economic burden with the expenditure of 6.329 billion,55.40 billion,4.26 billion,3.924 billion and 3.569 billion respectively.3.In the 866,371 inpatient sample information,the proportion of female was higher than males.The average inpatient expenditure for males was 7216.59 yuan,while the expenditure for females was 5735.35 yuan.The circulatory system,respiratory system,gestation period of pregnancy,digestive system diseases and tumors are the diseases with the largest number of hospitalized cases,and the proportion were 15.99%,13.70%,9.81%,9.42% and 8.39% respectively.The diseases with the highest average inpatient expenditure are tumors(13535.07 yuan),congenital malformations(11,731.86 yuan),and Damage poisoning(10879.06 yuan).There was a significant difference in hospitalization expenditure among different age groups.The average and median hospitalization costs were the highest in the 55-64 age group.Residents who pay through urban employee medical insurance have the highest average hospitalization expenses.More patients choose to be hospitalized in county level hospitals or below,accounting for 55.19%.4.The number of staydays,the county-level or below medical institutions,age,drug fees,and surgery fees have the greatest impact on hospitalization expenditure in Gansu Province.Diseases such as genitourinary system,external causes of death,pregnancy and childbirth,respiratory diseases,tumors,and injuries and poisoning have a greater impact on hospitalization expenditure.Conclusions: 1.Health expenditure in Gansu Province is growing rapidly,but the burden of residents in actual medical services is heavy.The results of current health expenditure can truly reflect the situation that the heavy burden of medical expenses for residents.It suggested that at the time of improving government investment,more attention should be paid to reform supply-side structure,optimize the allocation of health resources and accelerate rational use of health funds in medical consumption.2.The “short board” of health fund allocation is obvious: the medical service capacity of primary health care institutions is weak,the emphasis on preventive services needs to be strengthened,health financing channels are single,and medical funds need to be optimally allocated.3.The coverage of basic medical insurance showed insufficient for some outpatient services.The coverage of key diseases such as injuries and infectious diseases needs to be further expanded.Medical insurance for children needs to be improved4.Staydays,medical treatment at the county level or below,age,drug costs and surgery fees are five factors that mainly affect the inpatient expenditure of residents in Gansu Province.5.Diseases such as genitourinary system,the external cause of death of the disease,pregnancy and childbirth,respiratory diseases,tumors and damage poisoning have a great impact on the hospitalization expenses,of which the genitourinary system,the external cause of death and the respiratory system are protective factors.Pregnancy and childbirth,tumor and injury poisoning have a great impact on the increase of inpatient expenditure.From the perspective of expenditure control,the prevention and control of these diseases need to be highly valued.