Analysis On The Cost And Influencing Factors Of Outpatient Surgery In A Third Class Hospital

Objective: To extract the cost data of overall out-patient surgery in a third class A hospital from 2017 to 2021,and to understand the changing trend and structural changes of out-patient surgery cost over time.Through the analysis of the basic information of patients,payment categories,cost composition and other factors,to explore the influencing factors of outpatient surgery costs,to provide data basis for reasonable adjustment and effective control of outpatient medical costs.Methods: The cost information of outpatient coordinated surgery patients during2017-2021 and part of cash out-of-pocket surgery patients in 2021 were collected from HIS system of a certain three first-class hospitals.The cost information consisted of total medical expenses,medical insurance expenses,cash out-of-pocket expenses,treatment expenses,operation expenses,western medicine expenses and traditional Chinese medicine expenses.Extract basic information of outpatients,such as gender,age,occupation,etc.A total of 9956 items of information were included as research objects.The database was established by Excel and SPSS to study the internal composition and change trend of expenses,spearman correlation analysis,single factor and multiple factor analysis to study the correlation and influencing factors among expenses.The composition ratio was used for the comparison of different characteristics,and the structural change value and structural change degree were used for the cost composition ratio of different years.The independent sample t test was used for the comparison of outpatient cost of two categorical variables,the analysis of variance was used for the comparison of outpatient cost of three or more categorical variables,and the linear regression analysis was used for multiple factors.P < 0.05 indicated that the difference was statistically significant.Results:1.Among all ambulatory surgery patients,female patients were more than male patients.The average age of surgical patients was 46.13 ± 14.74 years old,and the number of medical workers was more active than retired or other.From 2017 to 2021,the number of outpatients increased year by year,among which superficial mass resection patients accounted for the highest proportion(43.8%).2.In terms of outpatient expenses,the overall surgical and medical expenses in the outpatient department of the hospital totaled 8,403,500 yuan in five years.The total cost of ambulatory surgery,medical insurance expenditures and out-of-pocket expenses all increased over the past five years.In the past five years,the medical insurance expenditure of outpatient surgery totaled 7.762,900 yuan,with per capita medical insurance expenditure of 1,117.52 yuan.The structural variation analysis showed that the structural variation of most surgical procedures was high in laboratory fees,examination fees and operation fees,while the variation of drug costs was small.However,cervical polypectomy was significantly different from other surgical procedures.The structural variation of western medicine costs was 7.61%,and that of traditional Chinese medicine costs was10.39%,which was much higher than other surgical procedures.The correlation analysis results of each cost found that there was a correlation between western medicine cost,traditional Chinese medicine cost and laboratory cost,while there was no correlation between Eisai cost and other costs.3.In terms of patients’ economic burden,the total proportion of outpatient surgery medical insurance expenditure in the past five years was 91.31%,and the per capita cash out-of-pocket payment was 106.42 yuan.The results of payment prediction in 2023 showed that the per capita self-expense increased by 392.92 yuan after the reform of mutual assistance in outpatient clinics,with a growth rate as high as 101.63%.The disease burden of ambulatory surgery patients increased after the reform of mutual aid.4.The comparison with the expenses of patients with cash self-payment shows that the total medical expenses of patients with cash self-payment are generally higher than those of patients with overall planning.Analysis of influencing factors showed that there was a statistically significant difference in the influence of the type of medical treatment on the medical costs of patients with superficial mass resection and patients with scalp mass resection(P< 0.05).The difference of the effect of settlement time on the medical cost of patients with temporal mass resection was statistically significant(P< 0.05).Age and settlement time had statistically significant effects on medical costs of patients undergoing breast mass resection(P< 0.05).Conclusion:1.From 2017 to 2021,the number of outpatients increased year by year,and the total cost of outpatient surgery,medical insurance expenditure,out-of-pocket cost and per capita cost all showed an increasing trend in the five years.2.There are differences in the cost structure and cost influencing factors of different surgical procedures.In the supervision of medical costs,the cost structure characteristics of different surgical diseases should be targeted at drug prices,service charges,inspection items,diagnosis and treatment norms and other aspects of supervision,so as to effectively control medical costs.3.Before the mutual aid reform,the overall medical insurance expenditure of outpatient surgery accounted for 91.31%,with a high level of compensation and security.After the reform,the proportion of patients’ self-payment increased significantly,and the economic burden of disease increased.Outpatient mutual aid reform,improve the overall level of medical insurance compensation.However,the expansion of the scope of compensation will inevitably affect the level of outpatient compensation for some patients,leading to an increase in the economic burden of disease.