A Study On Curative Expenditure Of Chronic Diseases In S Province Based On The "System Of Health Accounts 2011" Under The Background Of Population Aging

Objective: In 2021,the proportion of the population aged 65 and above in China has reached 14.2%,indicating that China has entered a deep aging society.As the proportion of the elderly population increases,so does the financial burden of Non-communicable diseases(NCD).Understanding the Financing,distribution,and changing trend of NCD costs is of great significance for reducing the financial burden of diseases of the elderly and alleviating social conflicts.The overall efficiency of health resource allocation in Province S ranks low in China,and the growth rate of the proportion of the elderly population is higher than the national average.Therefore,this study takes S province as the research object,measured its NCD treatment costs under different funding sources,institutional distribution,age distribution,and disease type distribution from 2016 to 2019,and studied its changing trend to supplement the current more comprehensive and comparable cost data for this area.At the same time,it explores how to control the unreasonable growth of NCD treatment costs from health policy perspectives and influencing factors,especially effective means for the rapid increase of NCD treatment costs for the elderly,to provide a more comprehensive reference for health policy formulation and intervention.Methods: The first part is based on the "System of Health Accounts 2011(SHA 2011)",an internationally recognized health cost accounting system,to account for NCD in S province from 2016 to 2019;The second part used the literature method,degree of structure variation(DSV),and regression discontinuity design(RDD)to analyze the changes of the“Zero-margin drug policy(ZMDP)” to the hospitalization cost structure and the average drug cost and total cost of patients with major NCD in S province;The third part used descriptive statistics to describe the number of hospitalizations and the average hospitalization costs for patients with major NCD in 2019.Using chi-square test,MannWhitney U test,Kruskal-Wallis H test,and multiple linear regression to analyze the influencing factors of the number of inpatients and the average hospitalization.Multigroup structural equation model was used to analyze the structural differences of the influence of different factors on hospitalization costs of patients with different age groups and different types of NCD.Results: Part one: 1.The cost of NCD treatment in S province increased from 36.963 billion yuan in 2016 to 50.563 billion yuan in 2019,and the per capita health cost of NCD increased from 1003.98 yuan in 2016 to 1355.87 yuan in 2019;2.The cost of NCD treatment for people aged ≥65 in S province increased from 13.564 billion yuan in 2016 to 18.423 billion yuan in 2019,and the per capita health cost increased from 3882.22 yuan in 2016 to 4503.37 yuan in 2019;3.The source of financing for NCD treatment showed that the proportion of household health expenditure had decreased year by year,from 35.29%in 2016 to 23.20% in 2019,a decrease of 12.09%;4.The distribution flow of NCD treatment cost showed that hospitals were the main type of medical institutions,accounting for about 90%.The expenses incurred in general care accounted for two-thirds of all hospital types;5、The age composition data in the total NCD treatment cost data in S province showed that the age of patients who spend NCD treatment costs was mainly concentrated in 50-69 years,and the NCD treatment cost of this age group accounts for nearly 50% of all NCD treatment costs in S province;6.The ICD-10 composition of the total treatment cost of NCDs showed that circulatory system diseases account for the highest proportion of all ICD-10 types,accounting for 34.04%,30.76%,33.15%,and 28.22%from 2016 to 2019,respectively,followed by the digestive system and tumours;7.There were differences in the distribution of ICD-10 treatment costs in different age groups,treatment costs in medical institutions in different age groups,and the distribution of ICD-10 treatment costs in different medical institutions.Part two: 1.After implementing the ZMDP,the proportion of hospitalization expenses for cancer patients in urban public hospitals dropped from 25.42% to 22.18%,and the proportion of drug cost of cancer patients ≥65 years old decreased from 38.15% to 26.60%;2.After implementing the ZMDP,the proportion of hospitalization expenses for patients with circulatory system diseases inurban public hospitals decreased from 34.51% to22.93%,and the proportion of drug cost with circulatory system diseases ≥65 years old decreased from 43.37% to 27.41%;3.ZMDP significantly reduced the average drug costs and hospitalization costs of cancer patients in urban public hospitals(P<0.05),however,it did not reduce the average drug costs and hospitalization costs patients of cancer patients≥65 years old(P>0.05);4.ZMDP could reduce the average drug cost of patients with circulatory system diseases and all age subgroups in urban public hospitals(P<0.05)but did not reduce the average hospitalization cost of the <65 years old(P>0.05).Part Three: 1.In 2019,the number of inpatients of cancer patients was 67,878,of which19,772 were in the ≥65 age group,accounting for 29.13%.The total number of inpatients with circulatory system diseases was 126,852,of which 62,379 were in the ≥65 age group,accounting for 49.17%;2.The number of inpatients of NCD patients in different age groups was related to the location of medical institutions,gender,insurance type,length of stay,medical institution level,whether surgery,whether they have other diseases and other diseases(P<0.05);3.The average hospitalization cost of the tumour was 9450.02 yuan,and the interquartile range was 14734.92 yuan;the average hospitalization cost of circulatory system disease patients was 8310.29 yuan interquartile range was 10576.64yuan;4.Univariate and multivariate results showed that the average hospitalization costs of NCD patients of different ages were related to the location of medical institutions,gender,insurance type,length of stay,medical institution level,whether surgery,whether they have other diseases and the influencing factors of different types of NCD were inconsistent(P<0.05);5.There are differences among the influencing factors of hospitalization expenses in different age groups and different types of NCD(P<0.05).Conclusion: Part one: The efficiency of health resource allocation in S province is low,and there are great differences between cities;The cost of NCD treatment is huge,and the growth rate is too fast.Inpatient services and the elderly consume a lot of health expenses;the proportion of NCD family health expenditure has decreased year by year,meeting the requirements of the national " the 13 th Five-year Plan";Circulatory system diseases,digestive system diseases and cancers are the main direct economic burdens of NCD in S province;There are differences in the distribution of NCD and treatment costs of medical institutions in different age groups,and the distribution of NCD treatment costs in different medical institutions.With the increasing aging of the population,the cost of treatment of NCD in S province will continue to increase,and the proportion of the elderly will increase.Therefore,local governments should continue to take targeted measures to strengthen the refined management of NCD in crucial populations,improve the utilization rate of health resources,and control the growth of NCD treatment costs within a reasonable growth range.Part two: Drug costs account for a large proportion of NCD hospitalization costs.After implementing the ZMDP,the proportion of drugs in urban public hospital medical institutions has decreased to varying degrees.However,the proportion of drugs has increased in varying degrees after implementation.It is more meaningful for elderly patients with NCD to cancel the drug markup.Medical institutions will make up for the loss of revenue from the ZMDP on drugs by adding other services.To further reduce the cost of medical for patients with NCD,the state should strictly stipulate the price range of medical service items,optimize the way of financial subsidies,and carry out dynamic compensation.At the same time,we need to promote the speed-up and expansion of centralized procurement and reduce drug transaction costs to reduce the cost of treatment for patients with NCD.Part three: Age,location of the medical institution,level of the medical institution,gender,length of hospital stay,type of medical insurance,whether surgery,and whether there are complications are the influencing factors for the number of hospitalizations and the average hospitalization cost for NCD patients.In addition,there are differences in the influencing factors of hospitalization costs among different age groups and different types of NCD.This provides a more accurate reference for controlling the reasonable growth of NCD treatment costs.To further reduce the disease economic burden of NCD patients,we should continue to promote the construction of a hierarchical diagnosis and treatment system,and guide NCD patients to seek medical treatment reasonably;Promote elderly care,develop the combination of medical care and elderly care;Strengthen the scientific management of hospitals,and control internal costs.