Analysis Of Hospitalization Cost And Influencing Factors Of Patients With Primary Liver Cancer In A Third-grade Hospital In Guangxi

ObjectiveGuangxi is an area with a high incidence of primary liver cancer.Through the analysis of the data items on the first page of the medical records of patients with primary liver cancer from 2015 to 2020 in a tertiary hospital in Guangxi,the factors that affect the hospitalization expenses of patients with primary liver cancer are explored,and provide a basis for the management of hospitalization medical expenses by medical institutions.Relevant departments provide policy recommendations for controlling the increase in hospitalization medical expenses,and provide reference for relevant departments to optimize the allocation of funds for the prevention and treatment of primary liver cancer.MethodsUsing Microsoft Excel 2010,the original medical record data extracted from the medical record information system of a tertiary hospital in Guangxi from 2015to 2020 were screened and excluded,and 6504 medical record data were finally included.Extract the patient’s sociodemographic characteristics,hospitalization-related clinical case characteristics,and individual expense information that constitute hospitalization expenses from the data on the medical record homepage.With 2020 as the base year,the national healthcare consumer price index is used to discount the hospitalization expenses in other years.The new gray correlation analysis method is used to quantitatively analyze the correlation between each individual hospitalization cost and the total cost;the structure change analysis method is used to analyze the structure change and change trend of each individual hospitalization cost and the total cost;SPSS25.0software is used to analyze the information of each variable Carry out general statistical description,single-factor analysis and multi-factor analysis of the patient’s hospitalization expense information.Because the hospitalization expenses of patients do not follow a normal distribution,non-parametric tests are used for univariate analysis,multiple linear regression analysis is used for multivariate analysis,and the value after Sqrt square root conversion of patient hospitalization expenses is included in the multivariate analysis.All statistical analysis The inspection levels in are allα=0.05.Results1.From the analysis of the basic conditions of patients with primary liver cancer,among the 6504 discharged patients with primary liver cancer,5620 were male patients and 884 were female patients,with a male to female ratio of 6.36:1.The average age of the patients was 52.19±11.50 years old,the median age was52 years old,and the peak age of patients onset was between 46 and 65 years old.96.91%of the patients are married;in the ethnic distribution,the number of Han patients is the largest,accounting for 58.92%of the total number of cases,followed by Zhuang patients,accounting for 38.75%;50.74%of the patients are farmers,and the incidence of farmer patients in 2015-2017 The proportion of the number has increased year by year,and has gradually decreased in 2018;the payment method for patients’medical treatment is mainly based on the basic medical insurance for urban and rural residents/employees,accounting for 91.07%of the total.From the information on the clinical characteristics of patients with primary liver cancer,89.96%of the patients were admitted as"yes";62.84%of the patients were discharged as"improved";the shortest hospital stay was 1 day and the longest was 60 days.The median was 15 days,and the average hospital stay of patients with primary liver cancer in 6 years showed an overall downward trend year by year;41.10%of the patients were pathologically diagnosed as hepatocellular carcinoma;37.32%of the patients were in stage III tumor stage;92.07%of the patients had complications Symptoms or complications;77.90%of patients underwent radical surgery or interventional therapy,of which the proportion of patients undergoing surgical and interventional therapy has increased year by year,while the proportion of patients undergoing medical treatment has gradually decreased.2.The median total hospitalization expenses for patients with primary liver cancer from 2015 to 2020 is 47812.63 yuan,of which 84.15%of the total hospitalization expenses for patients are below 60,000 yuan.During the 6 years,the total hospitalization cost per patient for primary liver cancer has shown a downward trend year by year,with slight fluctuations in 2017-2018.From the perspective of the composition of the individual costs,drug costs accounted for the largest proportion of total hospitalization costs,at 35.46%;followed by diagnostic costs and consumables costs,which were 21.09%and 16.39%.From the perspective of the trend of change,the cost of consumables has increased year by year in the past 6 years,and the growth trend is obvious;the overall medical service fee,diagnosis fee,non-surgical treatment fee,and surgical treatment fee have shown a slight increase trend,but not obvious;other expenses have been declining year by year.The range is obvious;the cost of medicines has decreased year by year after a small increase in 2015-2016,and the downward trend is more obvious;the cost of blood and blood products accounts for a relatively small proportion,and the fluctuation range is not obvious.3.Calculated by the new gray correlation analysis method,the results show that the cost of each single item of hospitalization and the total cost of hospitalization between 2015 and 2020 is the most related to drug costs,followed by diagnostic costs and consumables,and blood and blood products are the least relevant.fee.The order of relevance is ranked in order of drug expenses（1.00）,diagnosis expenses（0.89）,consumables expenses（0.87）,non-surgical treatment expenses（0.82）,surgical treatment expenses（0.81）,other expenses（0.79）,comprehensive medical care Service fee（0.78）,blood and blood product fee（0.77）.4.Calculated by the structural change analysis method,the results show that the total structural change of hospitalization expenses for discharged patients with primary liver cancer from 2015 to 2020 is 53.70%,and the average annual structural change is 10.74%.Among them,the structural change in 2016-2017was the largest with 24.01%,followed by 2017-2018 with a structural change of21.28%,and the structural change in 2015-2016 was the smallest with 4.46%.The major changes in the internal structure of the hospitalization costs of patients with primary liver cancer are consumables and medicines.The contribution rates of the two structural changes are consumables（35.68%）and medicines（30.82%）,with a cumulative contribution rate of 66.50%,Is the main factor affecting the changes in the structure of the total hospitalization expenses for patients with primary liver cancer in the past six years.5.Through univariate analysis,the results show that different age,occupation,marital status,discharge outcome,medical payment method,length of hospitalization,tumor pathology,tumor stage,treatment method,and whether there are comorbidities or complications,etc.,have an effect on primary liver cancer.The hospitalization expenses of discharged patients are statistically significant（all P<0.05）.The single factor analysis results of the patient’s gender,ethnicity,and admission conditions have a P value greater than 0.05.It can be considered that the hospitalization expenses of patients with primary liver cancer of different genders,ethnicities,and admission conditions are not The difference is not statistically significant.6.The results of multiple linear regression analysis showed that the factors affecting the hospitalization costs of patients with primary liver cancer were ranked in descending order:treatment method,length of stay in hospital,tumor stage,discharge outcome,and whether there were comorbidities or complications.The multiple linear regression equation can be expressed as:Y=-416.162+31423.771X_10-1+22259.356X_10-2+1564.366X₆-6716.375X_8-1-4499.579X_8-2-3173.369X_8-3-3133.390X_8-4+9586.096X_4-4+1419.305X₉-3954.169X7-2.Conclusion1.The direct financial burden of patients with primary liver cancer in Guangxi is too heavy.It is recommended that the relevant medical insurance departments increase the reimbursement ratio for major diseases such as malignant tumors.2.The incidence of primary liver cancer in farmers is relatively high,and government departments should intensify efforts to carry out cancer prevention and health education,cancer prevention screening,and early diagnosis and early treatment.3.The internal composition and trend of changes in the hospitalization expenses of patients with primary liver cancer are unreasonable.The proportion of medicines has declined,and the proportion of consumables has risen.The proportion of expenses reflecting the technical and labor value of medical staff is relatively low.The structure of hospitalization expenses needs to be further adjusted.4.The key external factors that affect the hospitalization costs of patients with primary liver cancer include:treatment method,length of stay,tumor stage,discharge outcome,and whether there are comorbidities or complications.Take corresponding cost control measures in response to the above influencing factors to effectively reduce the disease economic burden of patients with primary liver cancer.