Analysis Of Medical Expenses For Stroke In Ganzhou City Under The Reform Of DIP Payment

Objective:This paper evaluated the impacts of hospitalization costs for stroke patients before and after the DIP score payment reform in a Grade-III hospital in Ganzhou City,which provides a basis for improving the relevant policies of DIP payment.Methods:This study is a retrospective investigation with data from the Medical information Big Data Center of a Grade-III hospital in Ganzhou City.The settlement data of stroke inpatients in this hospital were collected from June 1,2019 to May31,2022.June 1,2021 was taken as the policy intervention point,including the basic information of stroke inpatients,inpatient information and inpatient medical expenses.SPSS 25.0 statistical software was used to analyze the basic information of patients,hospitalization information and hospitalization cost information.Grey correlation analysis and structural variation analysis method were used to analyze the variations in the internal composition of the total hospitalization cost before and after the reform.Multiple linear regression model was established by multiple stepup regression method that was applied to evaluate the influencing factors of medical expenses for stroke inpatients before and after the reform.Results:A total of 5713 inpatients were collected in the study.There was no significant difference between the rate of repeat hospitalization and the number of hospitalization per capita(P=0.096).The number of inpatients with medical insurance for urban residents enhanced obviously,and the proportion of self-paying patients decreased,13.3 percentage points lower than before the reform.The average length of hospitalization inpatients decreased,and the proportion of ≤10days was higher,which was 15.29 percentage points higher than before the reform.The proportion of patients leaving hospital without medical advice shows an upgraded trend;The proportion of patients requiring surgery increased by 26.27 percentage points compared with before the reform;The number and proportion of patients with other diagnoses were higher than before the reform.In terms of medical expenses,hospitalization expenses decreased by 1.60%,the difference was statistically significant(P < 0.01).The proportion of patients with≥20000 (?) tuples decreased slightly by 3.71%,and that with 15000 (?) ～ tuples reduced by 4.16%.From the perspective of individual medical,the expense of diagnosis and treatment and the cost of drugs ranked the first and second in the total hospitalization cost after the reform,above two items reduced to 61.93%,among which the cost of drugs decreased most obviously,the difference was statistically significant(P < 0.05).The proportion of consumable cost increased after the reform,the difference was statistically significant(P < 0.05).The cost of surgical treatment and the average cost per time of blood and its products were upgraded before the reform,with statistical significance(P < 0.05).The average sub-cost of comprehensive service fee decreased compared with that before the reform,and the difference was statistically significant(P < 0.05).After the reform,the top three contribution rates of structural change of total inpatient cost were diagnosis and treatment cost(32.77%),drug cost(29.16%)and consumables cost(21.78%).The value of structure variation for drug cost,comprehensive service fee and diagnosis and treatment cost showed negative variation,while the value of structure variation for surgical treatment cost,blood and its products cost and consumables showed positive variation.Among them,the cost of medicine(-8.28%),the cost of consumables(7.94%)and the cost of surgery and treatment(2.78%)changed greatly;After the reform,the difference of contribution rate between each individual cost is reduced.After the reform,the top three grey relational coefficients were diagnosis and treatment cost,drug cost and consumable cost.There are differences in the relational degree between individual and overall cost among different types of medical insurance.After the reform,the multiple linear regression model presents that there is a linear regression relationship between hospitalization cost and hospitalization days,hospitalization condition,discharge mode,operation or not,and admission mode.Conclusion:1.DIP score payment reform shortened effectively the average length of hospitalization of stroke inpatients and reduced the hospitalization costs of patients,suggesting that the reform had a profitable effect for optimizing the allocation of medical resources.2.After the implementation of the DIP score payment reform,the factors affecting the hospitalization costs of patients are reduced,which indicates to some extent that the DIP payment mode is more adaptable to the clinical complexity and variability than the traditional payment mode,but the length of stay,operation,admission condition and discharge mode are still the most important influencing factors,and the reform should be optimized from these aspects in the later stage.3.After the implementation of the DIP score payment reform,the internal structure of patients’ medical expenses tends to be more reasonable,but the comprehensive service fee and diagnosis and treatment fee are relatively small in the overall structure.The cost structure needs to be further optimized to improve the service value of medical personnel.