Study On The Hospitalization Expenses Of Elderly Patients Getting Off-site Medical Care

Objective: This study collected the hospitalization expenses and other relevant data of the elderly patients in a third-class hospital from 2017 to 2019.On the one hand,it analyzed the current situation of the elderly patients in different places,and on the other hand,it analyzed the factors influencing the hospitalization expenses and reimbursement proportion of the elderly patients in different places,so as to provide reference information for the continuous improvement of the policies of off-site medical care.Data and Methods: The data of this study is from the information of elderly inpatients in a hospital from 2017 to 2019,including the age,gender,main diagnosis,whether to operate,the number of days in hospital,the insured provinces,hospitalization expenses and the cost of each medical project.The information of 5099 patients was collected,2 patients with incomplete information were excluded,and 5097 patients who were hospitalized in different places were included in this study.Excel 2019 was used for descriptive analysis of sociological characteristics;spss25.0 was used for descriptive analysis and single factor analysis of hospitalization expenses and reimbursement proportion;gray correlation analysis was used to compare the correlation degree between various charging items and hospitalization expenses;cluster analysis was used for patients with different characteristics in different places;structural equation model was used to analyze the influence of hospitalization expenses and reimbursement proportion The influencing factors were analyzed.Results:(1)From 2017 to 2019,the number of patients hospitalized in different places in the sample hospitals increased year by year.Among the 5097 subjects,3616 were 60-74 years old,accounting for 70.94%;1441 were 75-89 years old,accounting for 28.27%;40 were 90 years old and above,accounting for 0.78%.There was no difference in sex composition.(2)Chronic diseases such as malignant tumor and circulatory system diseases are the main diseases of elderly inpatients in different places.The hospitalization cost of patients with malignant tumor is higher than that of patients with other diseases.For the same disease,the proportion of reimbursement is different in different provinces.(3)From 2017 to 2019,5097 patients in different places were directly settled in the investigated hospitals.These patients came from 26 provinces,among which Liaoning Province had the largest number of settlement person times,and the top three settlement person times in other provinces were Heilongjiang Province,Jilin Province and Inner Mongolia Autonomous Region.(4)ICD-10 was used to classify the diseases of elderly inpatients in the hospital from 2017 to 2019: in the three years,the number of malignant tumor inpatients was the largest,a total of 2110 person times,accounting for 41.40%;the second was circulatory system diseases,1838 cases,accounting for 36.06%;the third was eye and appendage diseases,340 cases,accounting for 6.67%.Different age groups of elderly inpatients have different disease types.The top five disease categories of men and women are slightly different.From 2017 to 2019,the top 10 diseases of elderly inpatients in different places in the three years are different,but they are all chronic non communicable diseases,among which malignant tumor and chemotherapy for malignant tumor account for a large proportion.(5)Cluster analysis was used to analyze the elderly patients in different places from 2017 to 2019.According to the clustering coefficient,26 provinces are divided into 8 categories.The number of inpatients,average hospitalization expenses per time and reimbursement proportion of different disease categories are different.(6)From 2017 to 2019,the total hospitalization expenses of elderly patients in different places increased year by year,and the average hospitalization expenses increased first and then decreased.The order of the cost correlation degree of each item influencing the hospitalization expenses is: drug expenses > consumables expenses > examination and laboratory expenses > medical service expenses > treatment expenses > bed expenses > other expenses.The main factors affecting the hospitalization expenses of elderly patients in different places are: whether the disease category is malignant tumor,reimbursement ratio,whether surgery,whether the disease category is musculoskeletal and connective tissue diseases,etc.(7)From 2017 to 2019,the reimbursement ratio decreased year by year,and the total hospitalization expenses increased year by year.Different provinces have different reimbursement rates for the same disease category,and inpatients in the same province have different reimbursement rates for different diseases.The main factors that affect the reimbursement rate of elderly inpatients in different places are: whether surgery,disease category,etc.Conclusion:(1)With the continuous improvement of remote medical treatment policy,the number of hospitalized elderly patients in remote medical treatment is increasing year by year.Among them,the proportion of inpatients in other provinces is higher than that in other provinces.The composition of the number of hospitalized elderly patients in different places is not completely consistent with the geographical distribution.(2)Chronic diseases such as malignant tumor and circulatory system diseases are the main diseases of elderly inpatients in different places.The hospitalization cost of patients with malignant tumor is higher than that of patients with other diseases.For the same disease,the proportion of reimbursement is different in different provinces.(3)The influence degree of different expense categories on the total hospitalization expenses is different: the drug expense has the greatest influence on the hospitalization expenses,followed by the consumables expense,and the examination and laboratory expense ranks the third.Relevant departments of medical insurance should increase the examination of medical items for patients in different places to prevent the occurrence of unreasonable charges in medical institutions.(4)After sorting the effect size of the influencing factors of hospitalization expenses,it was found that the main influencing factors were whether the disease type was malignant tumor,reimbursement proportion,whether surgery,whether the disease type was musculoskeletal and connective tissue disease,and whether the disease type was urogenital system disease.(5)After sorting the effect size of the influencing factors of reimbursement proportion,it is found that whether surgery,whether the disease category is eye and appendage disease,whether the disease category is circulatory system disease,whether the disease category is respiratory system disease,and whether the disease category is urogenital system disease are the main influencing factors.