Analysis Of Treatment Cost Accounting Of General Hospitals In Shandong Province Based On The System Of Health Accounts 2011

BackgroundHealth has become a livelihood issue that China and even the world attach great importance to."Universal health coverage" has become the common goal of health systems and health policies all over the world.With the continuous development of social economy and the increasing demand for health services,the total health expenses in China and even all countries in the world are increasing year by year,among which the medical expenses also show an obvious increasing trend,which brings a heavy burden to the country,society,families and individuals.From the institutional flow of treatment expenses,most of the expenses go to general hospitals.Shandong Province,as one of the most populous provinces in China,controlling the growth of medical expenses is an important task during the 12th Five Year Plan period.Full accounting and analysis of treatment service costs is not only the basis of preventing and promoting population health,but also the premise of controlling treatment costs.ObjectivesBy accounting and analyzing the treatment expenses of patients in comprehensive medical institutions in Shandong Province from 2017 to 2019,we can understand the age,disease,financing scheme distribution and institutional service function of patients,and study the twodimensional cross cost structure of different ages and different financing schemes,different ages and different diseases,financing schemes and service functions,To understand the scale of treatment service cost of general hospitals in Shandong Province from two aspects:horizontal and vertical(time perspective).Through analysis,we find out the diseases that need to be prevented and treated,the key intervention population,the problems existing in the process of financing and distribution,and the differences in the cost structure of different types of medical institutions.This paper analyzes and discusses the problems existing in the financing,distribution and use of treatment service fees in general hospitals in Shandong Province,so as to provide policy suggestions for promoting the accurate cost control of general hospitals and clarifying the focus of health investment in general hospitals in the future.MethodsBased on the extensive reading of relevant literature at home and abroad,78 comprehensive medical institutions in Shandong Province were selected by using the method of multi-level stratified sampling to obtain their outpatient and inpatient data.According to the"a system of health accounts 2011 Edition(SHA2011)" issued by OECD,Eurostat and World Health Organization,which is the basic accounting framework of health expense accounting system 2011,this study uses stata14.0 software to analyze the treatment expenses of comprehensive medical institutions in Shandong Province from 2017 to 2019 from the aspects of service functions,institutional distribution,financing sources and beneficiary groups.Results1.From 2017 to 2019,the total treatment cost of comprehensive medical institutions increased from 146741193900 yuan to 171427163900 yuan,with an increase rate of 16.82%;2.Results of one-dimensional analysis:from the perspective of service function,outpatient expenses account for 27-28%of the total medical expenses,and inpatient expenses account for 72-73%;From the perspective of financing sources,they are mainly public financing schemes,with government financing schemes accounting for only 5-7%and household health expenditure accounting for more than 30%;From the perspective of beneficiaries,the elderly population accounts for about 20%,but the medical expenses account for nearly half,which is significantly higher than that of children and working age population;Non communicable diseases accounted for more than 65%of the treatment costs in 2017 according to GBD;According to the classification standard of ICD-10,the top five treatment costs are circulatory system diseases,respiratory system diseases,digestive system diseases,tumors,injuries,poisoning and some other consequences of external causes;3.Results of cross dimension analysis:(1)from the cross dimension analysis of service function and financing source,the financing source composition of outpatient expenses and inpatient expenses in general hospitals is relatively consistent,which are mainly public financing schemes,including social medical insurance;In 2019,the second largest financing scheme for outpatient expenses and hospitalization expenses is family health expenditure,and the financing share borne by families in outpatient expenses is higher than that in hospitalization expenses;(2)From the analysis of service function and population age distribution,outpatient expenses and hospitalization expenses are mainly concentrated in the population aged 60-74,and the population aged 0-14 has the smallest proportion;(3)From the analysis of financing sources and population age distribution,with the increase of age,the proportion of public financing expenses increases gradually,reaches the peak between the ages of 60-74,and then decreases gradually,while the proportion of family health expenditure decreases gradually with the increase of age;(4)From the cross analysis of financing sources and population disease distribution,the public financing scheme,voluntary financing scheme and family health expenditure level of circulatory system diseases are high,among which the proportion of public financing cost is the highest,the diseases with the highest proportion of voluntary financing cost are congenital malformation,deformation and chromosome abnormality,and the diseases with the highest proportion of family health expenditure are the external causes of disease and death;(5)From the cross dimension of population age and disease distribution,the treatment service fees of people aged 0-14 are mainly used for congenital malformations,deformation and chromosome abnormalities.The diseases that consume the most treatment service fees in the age group of 15-29 and 30-44 are pregnancy,delivery and puerperium,and the diseases that consume the most treatment service fees in the age group of 45-59 are tumors and digestive system diseases,People over 60 years old consume the most treatment services for circulatory diseases;4.The total treatment cost of general hospitals is 6.08 times that of traditional Chinese medicine hospitals(28.210 billion yuan).The composition of their financing sources is consistent with the change trend.From the perspective of the beneficiary population,with the increase of age,residents are more willing to choose traditional Chinese medicine medical institutions,and traditional Chinese medicine medical institutions provide more services for infectious diseases,pregnant women,perinatal and nutritional diseases or diseases.Conclusions and suggestionsConclusion1.The treatment cost of general hospitals in Shandong Province has increased too fast,which is higher than the growth rate of GDP in 2019;2.The financing structure of treatment service cost is unreasonable and relatively single.It is dominated by public financing scheme and family health expenditure scheme.The proportion of family health expenditure is high and the voluntary financing scheme is low;3.The burden of treatment for key diseases and the burden of medical treatment for key populations are heavy.Children aged 0-14 and people over 60 have the highest consumption costs,which are congenital malformations,deformation,chromosome abnormalities and circulatory system diseases respectively.In addition,injury,poisoning and some other consequences of external causes consume a lot of costs,which also need to be paid special attention to;4.The proportion of health services is unbalanced,the share of financing borne by families in outpatient services is much higher than that in inpatient services,and the compensation for outpatient services is insufficient;5.Traditional Chinese medicine hospitals have limited medical service capacity and small service volume,and the problem of "strong in the West and weak in the middle" of the medical and health system is still significant;Suggestions1.Optimize the financing structure of treatment expenses,give rational play to the role of the government,give full play to the role of voluntary financing schemes,and reasonably control family health expenditure;2.Pay attention to the prevention and treatment of key diseases,increase health investment in the prevention and treatment of chronic diseases,strengthen the intervention of diseases in key populations,improve individual self-protection awareness,and advocate healthy behavior and lifestyle;Ensure the health of the elderly and set up special medical relief to effectively treat the diseases of the elderly;3.Give full play to the unique advantages of traditional Chinese medicine,combined with the characteristic services of traditional Chinese medicine,and guide residents to adapt to diseases.