Study On Hospitalization Costs And Influence Factors Of Primary Liver Cancer In A City Of Guangxi

Objective The goal of this study was to analyze the hospitalization costs and influence factors of patients with primary liver cancer(PLC)in a city of Guangxi from 2014 to 2018,and to explore the trend and main influencing factors of the hospitalization cost of patients with primary liver cancer within 5 years.At the same time,the decision tree was used to explore case groups study of PLC in Guangxi.In order to provide a scientific basis for better controlling the rapid rise of medical expenses,correctly guiding medical consumption,and reducing the disease burden of patients,this study also provides a methodological reference for the relevant health administrative departments to establish a prepayment system suitable for DRGs in Guangxi.Methods Data was collected from national health statistics information network direct report system,from which the homepages of medical records of patients discharged from a city in Guangxi were selected from January 1,2014 to December 31,2018.Data of patients diagnosed with primary liver cancer(ICD-10 code C22.951)upon discharge was screened,4085 patients were finally enrolled for analysis.The grey correlation and degree of structure variation annlysis statistical methods were used to analyze the internal structure of inpatient medical expenses.The multiple liner regression model was used to analyze the influencing factors of hospitalization medical expenses.Based on the decision tree model algorithm in data mining,a case mix model was established for the total hospitalization cost of liver cancer patients.Results(1)In 4085 patients,with 3450 males(84.46%)and 635females(15.54%).The age distribution was between 18 to 96 years,most patients were less than or equal to 55 years old,with a total of 2272 cases,accounting for55.6%.There were 3287 patients in tertiary hospitals and 798 patients in secondary hospitals,accounting for 80.47% and 19.53% respectively.1948 patients underwent surgeries,while 2137 patients did not receive surgical treatment.The hospital stay ranged from 4 to 99 days,the length of hospital stay varied,with 2621 patients staying for less than 15 days,1177 patients staying for 15 to 29 days and287 patients staying for over 30 days respectively,the proportions were64.16%,28.81%,and7.03%.The new rural cooperative medical insurance was the main medical payment method,with a total of 2,433 cases,accounting for 59.56%,followed by urban employee medical insurance,with a total of 832 cases,accounting for 20.37%.(2)The median secondary hospitalization cost of primary liver cancer was 11513.40 yuan from 2014 to 2018,Among them,the cost of hospitalization in 2014-2016 showed a downward trend,and it began to rise slightly after 2016.The top four components of the individual expenses of hospitalization in different years were medicine expenses,diagnosis expenses,comprehensive medical service expenses,and treatment expenses,and the total composition ratio of the top four items was between 84.62% and 88.93%.The grey correlation analysis showed that the largest correlation between the changes of individual expenses was the medicine expenses(0.941),followed by the diagnosis expenses(0.765),comprehensive medical service expenses(0.750)and treatment expenses(0.724);the analysis of structural variability showed that the contribution rate of the pharmaceutical expenses structure change was the largest(46.14%),followed by treatment expenses(19.71%),consumables expenses(16.09%),and comprehensive medical service expenses(10.03%),with the cumulative contribution rate of the four items reaching 91%.(3)The multiple liner regression models showed that the length of hospitalization,whether surgery,hospital level,blood transfusion,admission route and medical payment category were all independent influencing factors of hospitalization costs of patients with liver cancer.(4)The combination of primary liver cancer cases formed 10 DRGs groups,the result of the test incdicated that grouping effect was satisflying.Conclusion Compared with the per capita disposable income of local residents,the cost of hospitalization for patients with primary liver cancer in this city was relatively high,and the economic burden was relatively heavy.Medicine costs(42.8%)accounted for the largest proportion of hospitalization costs,followed by diagnosis expenses(18.3%)and comprehensive medical service expenses(15.5%),on the basis of reducing hospitalization expenses,the internal structure of expenses should be optimized,fully reflecting the true value of the majority of medical workers in the medical field,thereby gradually reaching the goal of developing hospitals with doctors’ skills and techniques.The length of hospitalization was the primary factor affecting hospitalization costs.Thus,under the premise of ensuring the quality of medical treatment,the study suggests that we should effectively shorten the invalid hospitalization days,and integrate a variety of strategies and measures to achieve the purpose of properly reducing the hospitalization cost of patients.The results of the case combination study showed that the grouping effect is reasonable,but it needs to be further improved.