Objective To describe and analyze both the direct impact of emergency service (ES) cost sharing and the indirect impact of drug cost sharing on emergency service utilization (ESU) in health insurance plans. Methods The author searched18 electronic databases which were in the evidence-based, public health, economic and social categories, respectively, 2 grey literature review resources and Google search engine, and the retrieval time was from June 21st, 2011 to September 19th, 2011. According to the inclusion criteria, data screening and extraction were conducted by two reviewers independently, and the differences were discussed by a third person or a review group. The theme analysis was adopted to systematically analyze both the direct and indirect impacts of cost sharing on ESU. Additionally, the side effects were analyzed too. Results Among total 22 studies included, 13 described the direct impact of ESU cost sharing, while the other 9 referred to the indirect impact of drug cost sharing. There were mainly 5 categories of health plans involved in. The results showed that, ESU could respond to the cost sharing: ESU decreased when the proportion of copayment increased, and vice versa. The increase of drug copayment impaired the use of essential drugs and finally increased ESU. However, a modest ES copayment decreased the irrational ESU rather than the rational ESU. Conclusion To the insured, the increase of ES cost sharing would not decrease the rational ESU and has no adverse events, while the increase of drug cost sharing would lead to some adverse events such as the increase of ESU. To the uninsured, the impact of cost sharing needs to be further disccussed. So this review suggests, the proper ES self-payment should be introduced into the health insurance plans according to local economic status, resident income, etc.; in addition, the drug self-payment ratio should be determined cautiously.
Objective To investigate the orthopaedic inpatients’ disease and cost constitution of the Third People’s Hospital of Chengdu during 2008-2010, so as to provide detailed baseline data for further research on the factorial analysis of disease burden and effective intervention. Methods The medical records of inpatients in orthopaedic department of the hospital during 2008-2010 were collected, and the diseases based on the first diagnosis on discharge records were classified according to the International Classification of Diseases (ICD-10). Results During 2008 to 2010, the total number of inpatients increased year by year. Most of the male inpatients were the young and middle-aged, while the female were the old. The rank order of top 5 systematic diseases didn’t change, while there were 6 single diseases kept ranking as top 10 in those 3 years. The average cost per capita averagely grew by 8.97%. The top 3 constitution of hospitalization cost remained the same, which were material cost, drug cost, and treatment cost; while the top 3 payment modes of hospitalization cost were patient’s own expense, social security, and public expense. Among those payment modes, social security rose obviously, and patient’s own expense reduced generally. Conclusion a) The total number of inpatients increases yearly during 2008-2010, and the gender and age distribution of inpatients are tending towards stability. b) The spectrum of disease and single diseases classified according to the one-level code of ICD-10 are relatively stable in those 3 years; of which the top ranked disease is lumbar disc herniation, and the disease with most obviously rising trend is intertrochanteric fracturethe. c) The hospitalization cost per capita rises year by year, of which the constituent ratio of both material and examination costs grow obviously, but the operation, treatment and bed costs are still lower. It requires a multi-pronged approach to control the increase of hospitalization cost as well as the rationalization of cost constitution. d) Among all payment modes of hospitalization cost, the constituent ratio of patient’s own expense reduces year by year, while social security rises, indicating the medical security in national social security has been further expanded.
Objective To investigate the association between costs of hospitalized patients with diabetes mellitus and their complications in the West China Hospital of Sichuan University, so as to provide baseline data for further research. Methods We extracted the hospitalization case data of hospitalized patients with diabetes mellitus who were discharged from the department of endocrinology and metabolism, or discharged after being transferred to other departments for treatment from January 2011 to December 2012, using the hospital information system (HIS) of the West China Hospital of Sichuan University. The data included baseline of hospital patients, discharge diagnosis, hospitalization costs, and if their medical insurance had been registered in hospital. Then, we classified the diseases according to ICD-10 based on discharge diagnosis, coped the data using Excel 2010 software, and conducted statistical analysis using SPSS 13.0. Results a) In 2011, acute and chronic diabetes complication in diabetes inpatients were 11.9% (166/1 396) and 67.1% (930/1 396), respectively. Most of them had peripheral neuropathy and peripheral vascular disease. b) The most frequently-occurred complications were hypertension, followed by dyslipidemia, and osteoporosis. c) The median hospital stay was 13 days (7 to 9 days), and the median total cost of hospital/person-time was 6 578.88 yuan (4 186.93 to 10 953.89 yuan). d) The total cost and duration of hospitalization increased along with the increasing number of the chronic complications of diabetes. e) The diabetic foot patients were 255 person-times, the median duration of hospitalization was 18 days (13 to 29 days), and the median total cost of hospital/person-time was 16 672.19 yuan (10 903.93 to 28 530.37 yuan). Diabetes patients with foot complication had higher total costs and longer duration of hospitalization than those without foot complication. Conclusion Diabetes mellitus is one of the most important diseases in the department of endocrinology and metabolism, which is heavy disease burden. The costs of hospitalization and chronic complications are closely associated. Among these complications, diabetic foot is the heaviest disease burden.
Objective To analyze the costs of emergency medication in the West China Hospital within one month after Lushan earthquake based on actual medication of the victims’ disease spectrum. Methods We collected emergency medication data as evaluation index in the West China Hospital within one month after Lushan earthquake, including daily cost, cumulative percentage of pharmacology category, average cost per day/person, average cost per day/person when DUI=1, difference between average cost per day /person, and average cost per day/person when DUI=1, etc. Then, we input data using Excel software for statistically analyzing the costs of emergency medication within one month after the earthquake. Results During one month after the earthquake, the costs changed consistently with the number of victims, which implied the change of costs was rational. Injuries were classified into 6 categories and 12 kinds according to ICD-10. The costs of medication accounted for 71% of the total costs. Six kinds of illness accounted for 21%. Medication for injuries was classified into 3 categories and 18 kinds; average cost per day was 186.87 yuan and average cost per person was 1 702.70 yuan. Medication for illness was classified into 5 categories and 28 kinds; average cost per day was 38.96 yuan and average cost per person was 185.13 yuan. The mean value of average cost per day/person of injection was 14.52/5.08 times more than that of non-injection. Meanwhile, the mean value of average cost per day/person of imported medication was 7.10/5.28 times more than that of domestic medication. Conclusion The factors that impact the medication costs include: a) disease burden and traumatic conditions of the sick and wound; b) administration pathway (injection vs. non-injection); c) imported or domestic medication; and d) the rationality of taking DUI as evaluation index. When DUIgt;1, injection through the vein and imported medication take a larger share which increase the costs of medication. Emergency rescue package should mainly prepare for the injury. In order to ensure the timely, safe and effective medication, injection should be given priority to. We also should take into consideration crash-resistance/anti-quake package, reasonable dosage, convenience-to-use of drugs as well as the needs of the illness.
Objective To investigate the financial burden of in-patients with thyroid diseases in the West China Hospital in Chengdu, Sichuan province, from January 2011 to December 2012, so as to provide baseline data for further research. Methods The data of in-patients (who had been discharged from the department of endocrinology and metabolism or discharged after being transferred to other departments for diagnosis and treatment in the West China Hospital in 2011) were collected from the Hospital Information System (HIS) of the West China Hospital, including basic information, initial diagnosis when the patients were discharged, hospital costs, the information about whether the patients had been registered the insurance in hospital, etc. We classified diseases according to ICD-10 based on the initial diagnosis when the patients were discharged on the first page of case reports. The data were input using Excel 2010 software, and statistical analysis was performed using SPSS 13.0 software. Results The results showed that: a) in 2011, 205 person-times were hospitalized in the department of endocrinology and metabolism, of which, 84 were male and 121 were female, with mean age of 45.3±15.7 years; b) for patients with thyroid diseases, median hospital stay was 10 days, the average cost of hospital stay for each patient was RMB 2 881.43 yuan, most of which was for lab tests and examination; c) the person-times of patients with hyperthyroidism was 162, accounting for 79.5% of the total of thyroid diseases, median hospital stay was 10 days, and the average cost of hospital stay was RMB 2 958.36 yuan; and d) there was no association between the number of hyperthyroidism complications and hospital stay and costs. Conclusion Thyroid diseases are a commonly-seen disease in the department of endocrinology and metabolism, of which, hyperthyroidism accounts for the most. There is no association between the number of hyperthyroidism complications and hospital stay/costs.
Objective Through the analysis of hospital costs of 16 866 cases of patients with lung cancer in Sichuan Province, in oder to find the main influencing factors of hospital costs of patients with lung cancer, and to provide references for reducing the hospital costs of patients with lung cancer. Methods We selected information of in-patients with lung cancer in 6 hospitals in Sichuan province from January 2008 to December 2011 based on full consideration into the local economic levels geographics distribution of different regions in Sichuan province. Then we extracted baseline data, hospitalization data and costs, and then analysis on relevant influencing factors was performed using single factor analysis of variance and multiple stepwise regression analysis. Results A total of 16 918 cases are chosen, of which, 16 866 were effective for further analysis. The results of statistical analysis showed that, the cost of western medicine accounted for the most of the average of the total hospital costs (50.79%) , followed by the cost of diagnosis and treatment (40.79%). The reuslts of multiple stepwise regression analysis showed that, the top three factors influencing hospital costs most included hospital stay, operation, and regions. Conclusion Facing daily increasing costs of hospital costs of lung cancer, effectively reducing drug expenses of patients could be a breakthrough. We could ultimately reduce the hospital costs of patients with lung cancer as well as the the economic burden of patients and society, by strengthening hospital management, shortening hospital stay, and rationally regulating drug use.
Objective To investigate infertile inpatients hospitalized in Pingjin Hospital in Tianjin from 2008 to 2010, so as to provide baseline data for further research. Methods According to diagnosis criteria of WHO, we collected demographical characteristics, disease cause and cost constitution of infertility inpatients hospitalized in Pingjin Hospital in Tianjin from 2008 to 2010. The data of each patient were input into ACCESS database and SPSS 13.0 was used for statistical analysis. Results a) From 2008 to 2010, there were 1 452 infertile patients from 33 different areas of mainland China, 79.7% of which was from the north of China. b) The mean age was 31.2±4.3 years old. The percentage of patients aged 30 to 34 years accounted for the most (40.3%). Mental laborers (23.3%) were more than physical laborers (7.2%). 36.7% of patients received education from universities and 83.1% of patients had family income ranging from 20,000 yuan to 190,000 yuan. c) The mean age of the first sexual activity was 21.4±2.9 years old. 53.7% of patients had only one sexual partner and most couples had sexual activities twice every week. The mean age of husbands was 32.9±5.5 years old with the highest percentage of 30 to 35 years old (39.2%). The percent of intellectual work of husband was the highest (35.9%). 64.9% of patients had normal semen analysis results and 23.0% never took related examination. d) 29.9% of patients was primary infertility and 70.1% was secondary infertility, of which 57.6% had either induced or medical abortion. The mean duration of infertility was 5.2±3.5 years (range 1 to 21 year). e) 76.3% of infertile patients had pelvic adhesion and 88.6% suffered from tubal disease. Among the tubal infertile patients, 23.6% had uterine disease, 5.2% had ovarian disease, 5.0% had endometriosis, 6.7% had multiple problems, and 4.8% had unexplained infertility. In patients with tubal infertility, the incidence of distal fimbria atresia (45.8%) was higher than that of proximal block (32.9%). 24.7% of patients with fimbria atresia had hydrosalpinx and among of them, 21.1% had no hydrosalpinx. 15.2% had congenital tubal defects. f) The average hospital stay was 10.5 days and the cost was 14 253.3 yuan per person. The percentage of material cost was 29.1% and that of drugs was 18.2%. Conclusion a) The total number of infertile inpatients was 1 452 in gynecology department of Pingjin Hospital of Tianjin from 2008 to 2010. 79.7% of patient was from North China. Most of them were 30 to 34 years old and 44.3% had no job. The percentage of patients had university education and that of low-middle family income was the highest. Sexual activity was relatively traditional. Most husbands were 30 to 35 years old and intellectual workers, and 23.0% of them had never taken an examination of semen analysis. More patients were secondary infertile, and the duration of infertility was 1 to 21 years. b) 76.3% of patients had pelvic adhesion and 88.6% had tubal disease. The incidence of distal tubal fimbria atresia was higher than proximal tubal occlusion. c) The average hospital stay was 10.5 days and the cost was 14 253.3 yuan per person which was further lower than each cycle cost of assisted reproductive technology. The overall costs included materials and drugs (47.3%), which were mainly at patients’ own expense.
Objective To investigate financial burden of in-patients with hypothalamus-pituitary-adrenal gland/gonad diseases in the West China Hospital of Sichuan University, 2011, so as to provide baseline data for further research. Methods The data of in-patients (who had been discharged from the department of endocrinology and metabolism or discharged after being transferred to other departments for diagnosis and treatment in the West China Hospital in 2011) were collected from the Hospital Information System (HIS) of the West China Hospital, including basic information, initial diagnosis when the patients were discharged, hospital costs, the information about whether the patients had been registered the insurance in hospital, etc. We classified diseases according to ICD-10 based on the initial diagnosis when the patients were discharged on the first page of case reports. The data were input using Excel 2010 software, and statistical analysis was performed using SPSS 13.0 software. Results The results showed that: in 2011, 352 person-times of in-patients with hypothalamus-pituitary-adrenal gland/gonad disease as first diagnosis were hospitalized in the department of endocrinology and metabolism, of which, 139 were male and 213 were female, with mean age of 42.9±15.0 years; and b) median hospital stay was 11 days, the average cost of hospital stay for each patient was RMB 4 361.09 yuan, most of which was for lab tests, examination, and biomedicine cost. Conclusion Hypothalamus-pituitary-adrenal gland/gonad diseases are an important health problem in the department of endocrinology and metabolism in a Triple-A Hospital. Most of hospitalization costs are for lab tests, examination, and biomedicine cost.
Objective To investigate the variation of total hospitalization cost for single-diagnosed disease of different types of acute appendicitis in a three-A hospital, so as to provide evidence for the reimbursement amount of social medical insurance. Methods All patients with acute appendicitis who had surgery treatment during January-April 2011 (before implementing the fee system for single-diagnosed disease) and January-April 2012 (after implementing the fee system for single-diagnosed disease) were collected in this study for analysis. According to the types of acute appendicitis, the patients were stratified into the low risk group (simple, suppurative and gangrenous) and the high risk group (perforative, abscess-formed and pregnancy-combined). The correlation between total hospitalization cost and types of acute appendicitis, as well as the changes of total hospitalization cost after implementing the fee system for single-diagnosed disease were analyzed. Results A total of 90 eligible patients were included. The disease types were positively correlated with hospital stays and total hospitalization cost. All three types in the low risk group could control the average total hospitalization cost within RMB 10 000 yuan. The results of sensitivity analysis showed that, before implementing the fee system for single-diagnosed disease, the total hospitalization cost up to RMB 6 000 yuan could be positively correlated with the above risk stratification (r=0.442, P=0.003). After implementing the fee system for single-diagnosed disease from January to April 2012, the constituent ratio of hospital stays, compared with that in the same period of 2011, had no significant difference (P=0.108) between the two groups; but the ratio of hospital stays (less than 5 days) increased from 45% to 64%, and the ratio of hospital stays (greater than or equal to 10 days) decreased from 17% to 4%, indicating a tendency of shortening hospital stays. Also, the constituent ratio of total hospitalization cost had no significant difference (P=0.114) between the two groups; but the ratio of total hospitalization cost (greater than or equal to RMB 9 000 yuan) decreased from 32% to 13%, indicating a tendency of lowering total hospitalization cost. Conclusion The low risk group of acute appendicitis, RMB 6 000 yuan should be rated as the rational reimbursement amount of social medical insurance. The total hospitalization cost for the high risk group is quite various, so the further studies are needed to investigate the feasibility of the fee system for single-diagnosed disease as well as the rating amount of total hospitalization cost. The implementation of the fee system for single-diagnosed disease is helpful to shorten hospital stays and reduce total hospitalization cost.
Objective To Investigate the disease constitution and hospitalization expense in Luxi township health center (LxC) in Yongxi county of Jiangxi Province in 2010, to make clear about the local burden of diseases and to provide the baseline data for further study. Methods The inpatient records of LxC in 2010 were collected. Based on the primary diagnosis on hospital discharge record, the diseases were standardized and classified according to the International Classification of Disease, 10th Edition (ICD-10). Data including general information of the inpatients, discharge diagnosis, hospitalization expense and usage of essential medicine etc, were reorganized and analyzed by using Microsoft Excel 2003 and SPSS 13.0 software. Results a) The total number of inpatients were 925 in 2010, with male/female ratio of 0.8; b) The disease spectrum included 17 categories, accounting for 81% of the ICD-10; c) The top 5 diseases were in respiratory, digestive, injury, poisoning amp; external causes, circulatory and genitourinary system, totally accounting for 82.27%; d) The top 15 single diseases were upper respiratory infection, fracture, chronic obstructive lung disease (COPD), chronic gastroenteritis, cerebrovascular disease (CVD), calculi in urinary system, rheumatoid arthritis, intervertebral discs diseases, cholecyslithiasis accompanied with cholecystitis, cardiac disease, reproductive organ diseases, injury amp; poisoning, pneumonia, hypertension and peptic ulcer; e) The patients with upper respiratory infection and pneumonia were mostly older than 65 or younger than 5 years old. With the exception of calculi in urinary system and peptic ulcer, all the other 8 chronic diseases were mainly seen in patients over 65 years old; f) Among the 15 single diseases as listed above, the chronic diseases were associated with shorter average hospital stay and low average expense compared with the acute diseases (4.8 d vs. 11.6 d; ?439.1 vs. ?666.9); and g) The hospitalization expense of LxC, although increasing year by year, was still far below that of the national township health centers (?542.3 vs. ?1 004.6). Conclusion a) The top 3 in inpatients systematic diseases of LxC are respiratory system, digestive system, and injury and poisoning; the former 2 diseases attack more often in females, and the acute diseases are mainly infection and fracture; b) Except for rheumatoid arthritis, cholecyslithiasis accompanied cholecystitis, cardiac diseases, reproductive organ diseases and peptic ulcer, all the other 10 of the top 15 single diseases are similar to Yong’an township health center (YaC) in Sichuan Province in 2010; c) The acute diseases mainly focus on respiratory system, and injury and poisoning, and the chronic diseases mainly focus on digestive system, circulatory system, genitourinary system, the musculoskeletal system and connective tissue system; d) The number of patients who suffer from chronic diseases increases significantly when over of 35 years old, especially, often seen in female rather than male. The acute burden diseases is serious in patients less than 15 or more than 45 years old; e) The upper respiratory infection and pneumonia mainly affect the old and children; f) Compared with Xintian township health center (XtC) in Gansu Province, the average hospital stay of fracture patients is longer (43.7 d vs. 9.0 d), the hospitalization expense is higher (?1 948.0 vs. ?1 648.3), and the diseases is burden heavier (8.1% vs. 4.9%); and g) The average hospital stay of patients with acute diseases is longer than YaC and XtC (11.6 d vs. 3.7 d, 6.2 d), but the hospitalization expense is lower than both of them (?666.9 vs. ?850.4, ?906.9).