| Objective:This paper analyzes the hospitalization expenditure of tertiary public hospitals in Jilin Province from 2015 to 2018,studies the changes and trends in the number of hospitalizations,the average per-patient hospitalization expenses of patients with different characteristics,and the average per-patient drug expenses in tertiary hospitals before and after the implementation of the zero-rate drug policy,explores the impact of the zero-rate drug policy on the hospitalization expenses of patients in tertiary public hospitals in Jilin Province,evaluates the effect of the implementation of the zero-rate drug policy,provides data support for the government to take effective measures to optimize the structure of patients’medical expenses and control the unreasonable growth of medical expenses,and provides theoretical references for further deepening the reform of the medical and health care system.Methods:Based on the literature study and policy analysis,a stratified sampling method was used to select tertiary public hospitals in some regions of Jilin Province as the sample institutions for the study.Based on the literature study and policy analysis,a stratified sampling method was used to select tertiary public hospitals in some regions of Jilin Province as the sample institutions for the study.The records of the inpatient visits from January 2015 to December 2018 were selected from the sample institutions’medical case system,including indicators such as age,gender,admission date,total hospitalization expenses,drug expenses,medical insurance category,and disease category.Stata17 was used to perform relevant descriptive statistical analysis on the data and construct an interrupted time series analysis model.Finally,draw the piecewise linear regression charts based on the interruption time series analysis to intuitively express the trend of patients’hospitalization expenses before and after the implementation of the drug zero difference policy.Results:In this study,a total of 20,18889 inpatient treatment records were obtained from tertiary public hospitals in Jilin province proper,Jilin city,Tonghua city,and Baicheng city as sample institutions in the final sample.（1）In terms of the number of hospitalizations,males accounted for 48.52%,females accounted for 51.48%,and the proportion of female patients was higher than that of males.Among patients of different ages,8.66%were under 15 years of age,61.17%were 15-65 years of age,and 30.17%were 65 years of age and above,among which patients aged 15-65 accounted for the highest proportion.Among the patients of different insured categories,50.52%were urban employees,21.15%were urban residents and 28.33%were self-pay patients,of which urban employees had the highest percentage of inpatients.Among patients with different disease categories,11.96%were patients with infectious,maternal,perinatal and nutritional diseases,68.03%were patients with chronic non-communicable diseases,5.28%were patients with diseases due to injuries,and 14.73%were patients with other diseases,with chronic non-communicable diseases accounting for the highest percentage.（2）On the distribution of hospitalization expenses:among patients of different genders,the average hospitalization expenses of male were 16,843.64 yuan and the average drug expenses were 5,896.38 yuan,for female,the average hospitalization expenses were 13,165.12 yuan and the average drug expenses were 4,649.06 yuan.Both the average hospitalization expenses and the average drug expenses for male were higher than those for female.Among patients of different ages,the average hospitalization expenses of patients under the age of 15,patients aged 15-65 and patients aged 65 and over were 8,502.43 yuan,14,981.97 yuan and 16,729.02 yuan respectively,and the average drug expenses were 2,241.39 yuan,5,087.89 yuan and6,371.88 yuan respectively.Among them,the average hospitalization expenses and average drug expenses of patients aged 65 and over were the highest.Among the patients of different insured categories,the average hospitalization expenses of urban employees,urban residents and self-pay patients were 13,930.07 yuan,12,571.16yuan and 17,026.29 yuan,respectively;and the average drug expenses were 5,414.13yuan,4,827.42 yuan and 5,264.38 yuan,respectively.Among them,the average hospitalization expenses of self-pay patients was the highest,and the average drug expenses of urban employees patients was the highest.Among patients with different disease categories,the average hospitalization expenses and drug expenses of patients with infectious diseases-pregnant women-perinatal and nutritional diseases,patients with chronic non-communicable diseases,patients with diseases caused by injury and patients with other diseases were 9,240.56 yuan,15,831.30 yuan,26,595.75 yuan,12,754.76 yuan and 3,533.51 yuan,5,248.21 yuan,7,017.06 yuan,5,943.03 yuan respectively.Among them,the highest average hospitalization expenses and average drug expenses for patients with diseases caused by injuries.（3）Evaluation on the implementation effect of the zero-rate drug policy based on interruption time series analysis model:among patients of different genders,after the implementation of the zero-rate drug policy,the instantaneous levels of average hospitalization expenses and average drug expenses of male and female decreased by1,581.40 yuan,2,331.06 yuan and 1,081.37 yuan,1,104.04 yuan respectively（P<0.001）.Compared with the pre-policy implementation,the upward trend of the average hospitalization expenses over time was slightly slowed down for male（β3=-67.21,P<0.05）,and downward trend over time of average drug expenses（β3=-62.29,P<0.001）,while the increase in average hospitalization expenses and average drug expenses was more intense for women（average hospitalization expenses:β3=129.68,P<0.001,average drug expenses:β3=24.89,P<0.05）.Among patients of different ages,after the implementation of the policy,the instantaneous levels of average hospitalization expenses and average drug expenses decreased by1,127.18 yuan,2,761.15 yuan,1,164.22 yuan and 769.67 yuan,1,276.41 yuan,1,004.04 yuan for patients under the age of 15,15～65,65 and over,respectively（p<0.001）;Compared with the pre-policy implementation,the average hospitalization expenses of patients of all ages still showed an upward trend with time after the implementation of the policy,but the increase of patients under the age of 15 and over the age of 65 was slower than before（under the age of 15:β3=-78.23,P<0.001,65and over:β3=-32.17,P<0.001）,and the increase of patients aged 15～65 was more intense（β3=100.35,P<0.05）.Among the patients of different insured categories,after the implementation of the policy,the instantaneous levels of average hospitalization expenses and average drug expenses of patients of each insured category decreased by908.55 yuan,3,705.03 yuan,2,405.88 yuan and 962.19 yuan,1,725.59 yuan 989.74yuan,respectively（P<0.001）;Compared with the pre-policy implementation,After the implementation of the policy,the average hospitalization expenses for urban employees and self-pay patients still showed an upward trend over time after the policy implementation,and the increase was faster（β3=130.24,P<0.001;β3=66.33,P<0.05）,while the average hospitalization expenses for urban residents showed a downward trend over time,and the long-term downward trend was significant（β3=-150.88,P<0.001）).The average drug expenses for urban residents showed a downward trend over time after policy implementation,and the long-term downward trend was significant（β3=-81.61,P<0.001）,whereas the long-term trend change was not significant for urban employees and self-pay patients（P>0.05）.Among patients with different disease categories,after the implementation of the policy,the instantaneous levels of average hospitalization expenses and average drug expenses of patients with various disease categories decreased by 1,106.03 yuan,1,336.90 yuan,3,343.60 yuan,2,955.54 yuan,and 677.77 yuan,1,060.09 yuan,1,997.92 yuan1,600.89 yuan,respectively（P<0.001）.Compared with the pre-policy implementation,the slope of the upward trend in the average hospitalization expenses for patients with infectious diseases-pregnant women-perinatal and nutritional diseases and other disease categories was greater than before,（β3=101.79,β3=240.28,P<0.001）;the slope of the average hospitalization expenses for patients with diseases caused by injuries was significantly lower over time than before（β3=-358.61,P<0.001）;although the average hospitalization expenses for patients with chronic non-communicable diseases tended to increase over time,the effect of policy implementation on the change in the slope of the trend was not statistically significant（P>0.05）.The slope of the upward trend in the average drug expenses over time was greater for patients with infectious diseases-pregnant women-perinatal and nutritional diseases and other disease categories than before（β3=56.09,β3=68.73,P<0.001）,the upward trend in the average drug expenses over time was slower for patients with chronic non-communicable diseases（β3=-40.34,P<0.001）,and the average drug expenses showed a decreasing trend over time for patients with diseases due to injury,after the policy implementation（β3=-137.75,P<0.001）.Conclusion:1.There are differences in the population characteristics and average expenses of inpatients in tertiary public hospitals,which are shown as follows:in terms of gender characteristics,the number of hospitalizations for female patients was slightly higher than that for male patients,but the average hospitalization expense and average drug expense for males were both higher than that for females.In terms of age characteristics,the highest percentage of hospitalizations was for patients aged 15 to65,and the average hospitalization expense and average drug expense for patients aged 65 and above were the highest.In terms of the characteristics of insurance types,both the proportion of inpatients and drug expenses of urban employees were the highest.In terms of disease category characteristics,patients with chronic non-communicable diseases accounted for the highest proportion of all inpatients,and the average hospitalization expenses and average drug expenses are high.2.The impact of the zero-rate drug policy on the hospitalization expense of different characteristics of the population varies,which are shown as follows:in terms of gender characteristics,after the implementation of the policy,the upward trend in the average hospitalization expenses over time slightly slowed down for males,while the average drug expenses decreased over time,and both the average hospitalization expenses and the average drug expenses increased over time for females.In terms of age characteristics,the increase of the average time hospitalization expenses of patients under 15 and 65 and older were slower than before,and the average drug expenses of patients aged 65 and over showed a downward trend over time.In terms of insurance categories,the average hospitalization expenses and drug expenses of urban residents showed a downward trend with time,while the long-term trend of hospitalization expenses of urban employees and self funded patients was not significant.In terms of the characteristics of disease categories,the rising trend of the average hospitalization expenses of patients with diseases caused by injuries has slowed down significantly compared with the previous ones,and the average drug expenses showed a downward trend over time.The rising trend of the average hospitalization expenses and the average drug expenses of patients with infectious diseases-pregnant women-perinatal and nutritional diseases were more intense than before.The change in the long-term trend in hospitalization expenses for patients with chronic non-communicable diseases was not significant.3.After the implementation of the zero-rate drug policy,the average hospitalization expenses and average drug expenses of different characteristics of the population have decreased to different degrees,and the short-term effect of the policy is obvious.However,the long-term effect of the zero-rate drug policy on the hospitalization expenses of people with different characteristics is insufficient.The implementation of the policy has slowed down the rising trend of hospitalization expenses to a certain extent,but it has not changed the situation that hospitalization expenses continue to increase. |
