Analysis Of Hospitalization Expenditure Among Intracerebral Hemorrhage Patients Based On R Software

Objective:To study the personal characters and their hospitalization costs distribution and constitution among the description of hospitalization expenditure to the intracerebral hemorrhage inpatients with medical insurance in Tianjin from2003to2007. To find out the main factors influencing the hospitalization costs through the analysis of the data. To discover the potential reasons leading to the hospitalization costs overruns through in-depth of data mining. The analysis and exploration were used for the rational control of medical expenditure and the reduction of the financial burden of patients’ families.Methods:A random extraction of15%, totaled of3119intracerebral hemorrhage inpatients form the database of patients with medical insurance in Tianjin between2003and2007were included, a total of2895cases excluding hospital stay and times of hospitalization was "0" or missing were collected. The inpatients’ personal characters and the details of their hospitalization costs were analyzed using SPSS13.0software for the general statistical description. Multiple linear regression model was used to analyzed the patients’ hospital costs and the impact factors, association rules analysis in the data mining carried out by Apriori algorithm was used to explore the factors leading to the hospitalization costs overruns. R(2.14.2) software was used for the multiple linear regression analysis and association rules analysis to the patients’ hospital costs.Results:(1) The median of total medical costs per capita with medical insurance in Tianjin between2003and2007was10913.17RMB Yuan. The drugs fees (47.7%), treatment fees (25.3%) and tests fees (10.3%) in the total of hospitalization costs took the first three highest proportions, a total of83.3%, which took the main part of the hospitalization costs. The costs of the5years took an upward trend, but down slightly in the year of2005. Male patient accounted for68.5%of all the patients. The average age of the patients was (63.46±11.98) years old, the young group accounted for4.9%, the middle age group accounted for31.7%, and the elderly group accounted for60.4%. Patients hospitalized once accounted for82.2%, and the rest hospitalized more than once. The median of hospital stay of the patients was19days, and (22.77±18.01) days on average. Those patients with surgery accounted for29.3%, no surgery accounted for70.7%. Those patients hospitalized in Class-1hospitals accounted for0,9%, patients hospitalized in secondary hospitals accounted for21.3%, and patients hospitalized in tertiary hospitals accounted for77.8%. Those patients insured in Six Urban Districts accounted for73.7%, patients insured in Binhai New Area accounted for5.1%, patients insured in Four Districts Around Downtown accounted for14.7%, and patients insured in Two Districts&Three Counties accounted for6.5%.(2)In the univariate analysis, differences of hospitalization costs in different genders, different age groups, and different hospital stay groups were not statistically significant (P>0.05). Patients with surgery had higher hospital costs than patients without surgery (P<0.05). Patients hospitalized in tertiary hospitals had higher hospital costs than that patients hospitalized in Class-1hospitals and secondary hospitals (P<0.05). Patients insured in Six Urban Districts and Four Districts Around Downtown had higher hospital costs than that patients that insured in Binhai New Area and Two Districts&Three Counties (P<0.05).(3)In the multiple regression analysis, the effects of gender and insured area factors on hospitalization costs were statistically significant (P>0.05). The patients’hospitalization costs increased with the increasing of patients" age and the increasing of hospital level, but decreased with the increasing of patient’ times of hospitalization. In all of the impact factors, hospital stay of patients had the greatest effect on hospitalization costs, while surgery was the second impact factor. The hospital level was the third impact factor, and tertiary hospitals had greater effect than Class-1hospitals and secondary hospitals.(4)The results of association rules analysis revealed that surgery and hospital stay were the first two main factors to the hospitalization costs overruns. Genders, hospital level and times of hospitalization also were the impact factors of the hospitalization costs overruns.Conclusion:We had the main factors affecting hospitalization costs through the general statistical description, multiple regression analysis and association rules analysis to the hospitalization costs of patients with medical insurance in Tianjin.For the patients, the ways to control hospitalization costs includes:1) under the condition of non-aggravated, the patients should be conservatively treated if they do not need surgeries. On the other hand, the surgeries must be taken as early as possible if they are essential to the patients.2) Restrict hospital stay and reduce the time of hospitalization rationally, to cut the test fees, materials fees, and berth fees during hospitalization.3) Patients should be hospitalized in low level hospitals if they needn’t be in tertiary hospitals.4) Patients of intracerebral hemorrhage should control the condition as early as possible, and for the people who are under high risk of disease should take preventive measures actively in order to reduce the risk of illness.For the decision-making department of public health, the medical resources should be planned and allocated rationally, and the system of medical insurance policy should be established and improved. Good policy could contribute to improving the quality of living and could be an important guarantee of building a harmonious society.