| Objective: To study the hospitalization cost and cost composition of lung cancer patients in 2015～2019 in a third Class A Hospital in a certain city,to find out the change law of hospitalization cost of lung cancer patients and to analyze its influencing factors.Suggestions are put forward to control the increase of medical expenses according to the influencing factors of medical expenses for reference of related departments.Methods: The hospital information management system of a third-class hospital in a certain city was HIS in 2015～2019,and 25107 patients who were admitted to hospital were diagnosed as lung malignant tumor.The database was established by using EXCEL、SPSS22.0,and the distribution of lung cancer patients was analyzed by general descriptive analysis,grey correlation method and structural change analysis,Further analyze the factors that affect the hospitalization cost of lung cancer patients and find out the direct and indirect factors.Results:1.Among all patients,59.18% were male and 40.82% were female.The number of male patients was higher than that of female patients,but the average annual growth rate of female patients was 33.58% significantly higher than that of male patients 19.60%.The average age was 62.17 ± 9.973,The majority of patients aged 60 years old accounted for 63.89%,and the majority of patients aged 60-70 years old accounted for41.25%.The pathological type of 85.73% patients was non-small cell carcinoma,among which adenocarcinoma was the majority,accounting for 74.29%.Among the tumor stages,there were more patients in stage III and IV,accounting for 59.67%.The average hospitalization days were 7.81± 4.706 days.2.The hospitalization cost of all patients with lung cancer showed a trend of increasing first and then decreasing.From 2015 to 2018,the hospitalization cost of lung cancer patients increased year by year,from 18,329.99 yuan in 2015 to 20,712.66 yuan in 2018,with an average annual growth rate of 3.24%,and decreased to 18,954.53 yuan in 2019.Drug expenditure showed a decreasing trend year by year,from 29.18% in2015 to 16.62 % in 2019.The overall inspection fee fluctuated,rising from 13.24% in2015 to 13.09% in 2019,with only a slight decrease to 11.44% in 2017.The treatment cost and the total out-of-pocket cost also showed a trend of increasing first and then decreasing.The treatment cost increased from 13.20% in 2015 to 21.88% in 2018,with an average annual growth rate of 21.81%,and decreased to 22.23% in 2019.Full out-of-pocket expenses rose from 28.58 % in 2015 to 36.66 % in 2018,with an average annual growth rate of 11.24 %,and dropped to 34.89 % in 2019.The correlation degree between each single item of expenses and hospitalization expenses from strong to weak is drug cost,total self-cost,treatment cost,examination cost,major examination cost,diagnosis cost,special treatment cost,blood cost and out-of-pocket payment.From2015 to 2019,drug cost(45.36%),treatment cost(32.61%),total out-of-pocket cost(8.60%)and out-of-pocket payment(7.51%)had a higher contribution rate of structural change,and the cumulative contribution rate of structural change was 94.08%.3.Univariate analysis showed that there were statistically significant differences in hospitalization duration and hospitalization cost among different sexes,age,marital status,occupation,admission condition,pathological type,metastasis or not,tumor stage,treatment method,operation type(P < 0.01).However,there was no statistical significance among different ethnic groups,types of medical insurance and ways of leaving hospital.In the further multiple linear regression analysis,it was found that the number of days in hospital,age,gender,admission condition,pathological type and operation type were the influencing factors of the hospitalization cost of lung cancer patients,and the regression equation was: Y1=3.277+0.542Y2+0.001X1-0.014X2+0.174X5-0.007X6+0.219X10.The number of days of hospitalization is the direct influencing factor of hospitalization cost,and its regression equation is as follows:Y2=0.509+0.001X1-0.031X2+0.211X5+0.029X6-0.031X7-0.017X9+0.054X10.Age,gender,admission condition,pathological type,metastasis,treatment and operation type also indirectly affect hospitalization cost by influencing the length of stay.4.In the path analysis,the size of the total path coefficient was LG hospital stay(0.542),admission condition(0.298),type of surgery(0.248),gender(-0.031),metastasis(-0.017),treatment method(-0.009),pathological type(0.008)and age(0.002).The effect of hospitalization cost on lung cancer patients was in the order of length of stay,condition of admission,type of operation,gender,metastasis,treatment,pathological type and age.Conclusion:1.The hospitalization cost of all patients with lung cancer showed an upward trend on the whole.The cost of medicines has been decreasing year by year.Inspection fees dropped only slightly in 2017.From 2015 to 2018,both the treatment cost and the total out-of-pocket cost showed an upward trend,and both of them decreased in 2019.There was no significant change in the cost of medical examination,special treatment,major examination and blood.Among the internal components of hospitalization cost,drug cost,treatment cost,total self-payment and self-payment have a great influence on the change of internal structure of hospitalization cost.2.Age,gender,pathological type,hospitalization condition and operation type are not only the direct factors affecting the hospitalization cost of lung cancer patients,but also the indirect factors affecting the hospitalization cost through the length of hospitalization.The transfer or treatment indirectly affects the hospitalization cost through the length of hospitalization.The controllable hospitalization days,operation types and treatment methods were analyzed and discussed,and corresponding cost control measures were developed to alleviate the economic burden of lung cancer patients.3.Medical institutions should not only actively introduce DIP payment according to the points,reasonably arrange the examination and treatment items of patients,but also reasonably maintain the number of days of patients in hospital,further optimize the internal structure of hospitalization costs,strengthen the proportion of supervised drugs,and improve the value of medical personnel’s technical service.The government should strengthen the publicity and education of lung cancer,actively implement the tertiary prevention of lung cancer,reduce the incidence of lung cancer,improve the medical insurance policy,and update the list of medical insurance reimbursement. |
PDF Full Text Request