Research On Children’s Leukemia Hospitalization Cost And Medical Security Level In Rural Areas Of Anhui Province

Objectives We aimed to analysis the current status and change trend of hospitalization expenses of childhood’s leukemia,as well as the factors which affect the hospitalization costs;to examine the insurance level.And to explore the implementation effect and existing problems of catastrophic disease insurance of New Rural Cooperative Medical Scheme(NRCMS)of childhood’s leukemia in Anhui Province.So as to provide data support for controlling the medical expenses increasement and alleviating the economic burden of children’s leukemia.Meanwhile,offering reference for improving medical security policies of children with leukemia.Methods According to the International Classification of Diseases Code(ICD-10),data of children’s leukemia inpatients,ranged from 0-14 years old(including 14 years old),were obtained from the provincial platform system of Anhui New Rural Cooperative Medical System between January 1,2013 and December 31,2017 in 16 cities.Software of Excel 2010 and SPSS19.0 were used to analyze the data.The measurement data were statistically described by median and interquartile range,while the counting data were described by frequency(composition ratio).Independent-samples T test,analysis of variance and nonparametric rank sum test were used to analyze the statistical differences of data.Also,multiple linear regression analysis were implemented to analyze the factors which influence the hospitalization costs.Results(1)The overall number of hospitalized patients with children’s leukemia increased from 2013 to 2017,with a higher increment speed occurred between 2016 and2017.The number of non-poor patients(8092)was higher than that of poor patients (1563),while the number of hospitalizations in provincial medical institutions(5412)were higher than that in institutions out-of-provincial(3785)as well as the municipal and below medical institutions(389).Besides,the number of hospitalizations paid by project(8653)was higher than that paid by disease(1002).(2)The hospitalizations of children with leukemia are mainly composed of drug costs(21.2%),testing costs(16.2%),treatment costs(11.8%)and materials costs(9.7%).(3)The overall trend of per-visit inpatient expenses of children’s leukemia was fluctuating and decreasing.The per-visit inpatient expenses of non-poor patients(7376.3yuan)was higher than that of poor(6133.6yuan).The per-visit expenses of inpatients who treated in out-of-provincial institutions(8331.9yuan)was higher than that of provincial medical institution(6492.5yuan)as well as municipal and below medical institutions(4895.1yuan).Also,the per-visit expense of inpatients who paid by disease(14300.5yuan)was higher than that of paid by project(6664.4yuan).Statistically significances were observed in all the variables(P<0.05).(4)The trend of per-visit compensation costs and the ratio of compensation were rising and fluctuating.The per-visit compensation costs(5174.6yuan)and compensation ratio(84.4%)in poor patients were significantly higher than those of non-poor patients.The per-visit compensation fees in institutions outside the province(4163.5yuan)was higher than that inside the province,and the compensation ratio in provincial institutions(69.2%)was also higher than municipal and below medical institutions(55.9%)and out-of-provincial medical institutions(51.2%).The per-visit compensation cost(13040.9yuan)and the compensation ratio(91.2%)for inpatient who paid by disease is significantly higher than those of project-based payment.Besides,statistically significances were observed in all the variables(P<0.05).(5)Multivariate linear regression analysis showed that the influencing factors of hospitalization costs were payment method,provincial medical institution,municipal medical institution,northern Anhui,age,central Anhui,family economic status and gender,and ranking from high to low by the degree of impact on hospitalization costs.Conclusions(1)The utilization of hospitalization services for children with leukemia has increased,and medical needs have been released significantly in recent yeras.(2)The choice of medical treatment for children’s leukemia has changed gradually,flowing from out-of-province to within province,and concentrated mainly in provincial designated medical institutions.In addition,the medical attraction to children’s leukemia in municipal and below medical institutions is limited.(3)The economic burden of children with leukemia has eased,yet,the burden followed by this disease is still heavy.The payment method and the level of medical institutions are important factors which influence the cost of hospitalization.(4)Drug fees,examination expenses,treatment expenses,and material costs are the main components of leukemia hospitalization costs.(5)The financial burden of hospitalization of poor patients has been greatly reduced,the need for hospitalization has been largely released,and the policy of health poverty alleviation has achieved remarkable effect.(6)The effect of NRCMS which reduces the cost of major illness is obvious,but the coverage needs to be expanded.