Analysis The Utilization Of Medical Services For The Insured Elderly In Quanzhou City And The Influencing Factors Of Their Utilization Of Medical Services

Objective:This study aims to acquaint the utilization of medical services and analyze the influencing factors of hospitalization expenses in medical services for the insured elderly with the medical treatment data of the insured elderly from the Insurance Scheme Claims Data in Quanzhou City.Knowing the health status and health service demand of the insured elderly can provide evidences when making policy to improve the health of the elderly for relevant health departments.Methods:This study analysis the data of the outpatient and hospitalization service in the Insurance Scheme Claims Data in Quanzhou City from 2013 to 2017.Adopt the Statistical Description analysis the utilization and cost of medical services for the insured elderly(such as visits,total medical costs and so on).This research uses the fixed base ratio and sequential to analysis of incremental demand and growth trend of medical resources.Use the Adaptive-Lasso model and BP(Back Propagation)neural network model to analysis the might influencing factors of the elderly hospitalization cost.Analysis the advantage ratio of internal impact factors of hospitalization cost influencing factors with generalized estimation equation.Result:From 2013 to 2017,a total of 4.6294 million elderly people were insured in quanzhou,with 12.6 percent of UEBMI,5.9 percent of URBMI and 81.5 percent of NRCMI.The proportion of male insured is 47.05%;The proportion of those aged 6069 was 57.52%.Over the past five years,the number of elderly people taking part in the UEBMI、URBMI and NRCMI had been increasing year by year;the proportion of those aged 60-69 was the highest and increasing year by year.(UEBMI=the urban employee basic medical insurance,URBMI=the urban resident’s basic medical insurance,NRCMI=the New rural cooperative medical insurance)By analyzing the general situation and cost of the outpatient from 2013 to 2017,it can come out that:The number and visits of outpatients for the insured elderly increased year by year,with a total of 1.56 million and 9.80 million in the past five years.The proportion of males was 47.7%,and the proportion of 60-69 years old was 52.4%.The number of outpatient service、outpatient visits and the total cost of outpatient service had increased year by year.The median personal annual cost of outpatient service and the composition of outpatient service cost had changed year by year:(1)The cumulative quantity of increase on the number of outpatient who take part in the UEBMI、URBMI and NRCMI and their outpatient visits were respective 29.9%,48.7%;152.64%,165.83;,29.69%,1112.2%;the average growth rate was 6.76%,10.43%,26.07%;27.09%,6.63%,20.55%。The total cost of outpatient clinics cumulative increased respectively 66.62%,163.01%,66.62%;the average growth rate was 13.61%,27.35%,13.61%.(2)For the median cost of the individual year’s clinic;the number was raised year by year,the median of the UEBMI elderly rose from 714.9RRMB to 1147.2RMB,and the median of the "NRCMI" elderly rose from 264.4RMB to 416.8RMB.The median of the URBMI elderly was changed from 1219.8RMB to 1778RMB every year.Its highest and lowest values appear at the year of 2013 and 2017.(3)To the proportion of the cost of the outpatient,the proportion of expenses for medicine has been reduced year by year,and the proportion of inspection fee and medical service fee have been rising every year for the reform of the medical&health system and the implementation of the reform of the public hospitals.The proportion of expenses for medicine of the UEBMI and URBMI decreased from 83.16%and 86.15%in 2013 to 76.73%and 76.77%in 2017,respectively.However,the proportion of outpatient drug expenses of the NRCMI increased from 76.34 percent in 2013 to 78.78 percent in 2017.The results of this study also showed that the number of visits and the proportion of medical expenses in different types of outpatient institutions for the elderly who were insured changed to different degrees.Among them,the proportion of the UEBMI and URBMI in tertiary hospitals increased year by year,and the proportion of visits in tertiary hospitals was 42.46%and 35.91%respectively in 2017.However,the proportion of "town owned" hospitals for the NRCMI elderly declined year by year,and the proportion was still 72.32%in 2017.By analyzing the general situation of hospitalization,the composition of inpatient diseases and the cost of hospitalization from 2013 to 2017,it can be included that:(1)The number of inpatients and visits of the insured elderly increased year by year,with a total of 805,100 thousand and 1,205,500 thousand visits in the past five years.The proportion of males was 49.97%,and the proportion of 60-69 years old was 50.15%.The number of inpatient services,inpatient visits and the total cost of inpatient service had increased year by year:The median personal annual cost of inpatient service and the composition of inpatient service cost had changed year by year:①The cumulative quantity of increase on the number of inpatient who take part in the UEBMI,URBMI and NRCMI and their inpatient visits were respective 20.07%,22.12%;25.4%,27.78%,14.27%,14.05%;the UEBMI and URBMI average growth rate was 4.68%,5.12%;5.82%,6.32%;the NRCMI had the increase in volatility over a period of five years.The total cost of inpatient cumulative increased respectively 26.18%,51.85%,44.35%;the average growth rate was 6.97%,11.01%,9.61%。②For the median cost of the individual year’s hospital,the number was changed year by year,the median of the UEBMI elderly being between 9322RMB to 10096RMB,the median of the URBMI elderly being between 7216RMB to 8044RMB and the median of the "NRCMI" elderly being between 4334RMB to 6169RMB.During the five years,the proportion of the total cost of the hospital less than 5000RMB was changed every year:the proportion were from36.180,44.48%66.51%in 2013 to 35.01%41.16%,54.73%in 2017 by the UEBMI,URBMI and NRCMI.③To the proportion of the cost of the hospital,the proportion of expenses for medicine has been reduced year by year,and the proportion of inspection fee and medical service fee have been rising every year for the reform of the medical&health system and the implementation of the reform of the public hospitals.The proportion of expenses for medicine is still the highest,it descended from 49.01%,45.04%,43.17%in2013to29.82%,28.43,26.65%in2017by the UEBMI,URBMI and NRCMI.The results of this study also showed that the number of visits and the proportion of medical expenses in different types of inpatient institutions for the elderly who were insured changed to different degrees.Among them,the proportion of the UEBMI and URBMI in tertiary hospitals increased year by year,and the proportion of visits tertiary hospitals was 54.41%and 46.72%respectively in 2017.However,the proportion of "County owned" hospitals for the NRCMI elderly increased year by year,and the proportion was 38.45%in 2017.(2)The top five system diseases of the elderly are circulating system diseases,malignant tumors,respiratory diseases,musculoskeletal systems and connective tissue(cartilage,tendon,ligament)disease,eyes and other related organs,which are 71.96%in the total number of diseases,and the hospital expenses account for 75.4%of the total.The elderly often suffer from diseases such as hypertension,coronary heart disease,cerebral infarction,COPD,pulmonary infection,(branch)tracheal disease,senile cataract,cataclasis,lumbar spondylosis and arthropathy.Except for senile cataract and cataclasis,the incidence rate of males is higher than that of females.The hospitalization expenses of the insured elderly are accounted for 90.86%of the medical burden of the elderly.so Therefore,the influencing factors of hospitalization cost are analyzed to reflect the influencing factors of hospitalization burden.In the screening and analysis of the influencing factors of hospitalization expenses,it was found that the influencing factors of hospitalization expenses were:gender,age,place of insurance,type of insurance,hospital level,disease category,length of stay,comorbidity,and operation.Among them,"insured type" is the primary influencing factor,and the other important factors are the length of stay in hospital,whether surgery is performed,hospital level,disease category,comorbidities,insured place,age and gender.Taking the senile cataract as an example,the effect of influencing factor s on the cost was analyzed with the generalized estimation equation(quantitative analysis through the dominance ratio),such as the ratio of " UEBMI " URBMI "to the "NRCMI " was 1.189 and 1.120,the ratio of "primary hospital ","secondary hospital" to the "tertiary hospital" was 0.907 and 0.896,and the ratio of "no surgery" to "YES surgery" was 0.484.Conclusion:(1)The overall utilization of outpatient and inpatient medical&health services by the insured elderly is increasing year by year,such as the number of outpatient service,outpatient visits,total outpatient cost,median of outpatient individual annual cost,the number of inpatients and visits and the total cost of inpatients were all increasing year by year.The composition of outpatient and inpatient expenses changed year by year,but the proportion of pharmaceutical expenses was the hightest.The proportion of level-I hospitals was the largest on the consituation of outpatient medical institutions;however,the proportion of level-Ⅲ hospitals was the largest on the consituation of inpatient medical institutions.(2)For the different types of insurance,the outpatient treatment rate,the number of outpatient visits the hospitalization rate,the average number of hospitalization per person,the proportion of patients receiving medical treatment in tertiary hospitals,the length of stay,and the median cost of individual hospitalization for the UEBMI&URBMI elderly were all higher than those NRCMI elderly.However,the Medical burden ratio is lower than that of the NRCMI elderly.(3)The circulatory system disease,malignant tumor,respiratory system disease and so on are the elderly’ common diseases,strengthen to prevent and control these diseases can reduce effectively the incidence of these disease and the burden of the elderly,then improve the health level of the elderly,ease the demand medical resources caused by the aging.(4)In addition,the influencing factors of hospitalization expenses are length of stay,level of hospitals,surgery or not,and so on.The standardized treatment,the appropriate length of stay and the appropriate level of hospitals can effectively reduce the cost of hospitalization,and increasing the coverage and reimbursement ratio of medical insurance,can significantly reduce the burden of medical treatment for the insured elderly,so that the elderly in Quanzhou can choose more reasonable and rational medical and health services which needed.