Analysis Of Hospitalization Expenses And Influencing Factors Of Liver Transplantation Patients In A Tertiary Hospital And The Effect Of Case-based Payment

Objective:This study selected hospitalization expenses data of liver transplantation patients in a tertiary hospital in the surveyed area from January 1,2017 to September 30,2021.So as to analyze the close relationship between the total hospitalization expenses and individual expenses,and the internal composition changes of hospitalization expenses.Besides,exploring the relevant influencing factors of liver transplant patients’ hospitalization expenses,and the controlling effect of case-based payment on the hospitalization expenses of liver transplantation.This will provide scientific basis for adjusting the expenses structure of liver transplantation better and reduce the economic burden of liver transplant patients,so as to save medical insurance funds and ensure medical quality.Then provides reference for the reformation of medical insurance of DRG payment for liver transplantation in the surveyed hospital.Methods:Information of 324 liver transplantation inpatients from January 1,2017 to September 30,2021 were collected from the HIS system of a tertiary hospital in the surveyed area.Describing and analyzing the basic situation of patients,hospitalization expenses,expenses composition,the number of patients,coverage ratio of case-based payment,reimbursement ratio and self-payment ratio.The grey correlation analysis method was used to analyze the correlation degree of each individual hospitalization expenses.The internal structural changes of hospitalization expenses in 5 years was analyzed by the structural variation analysis.The difference-in-differences model was constructed to calculate the D-value between the pre-and post-case-based payment for analyzing the influencing factors of the hospitalization expenses、hospitalization days and reimbursement ratio of liver transplant patients.Results:1.Of the 324 patients,246 were male,accounting for 75.93%,and 78 were female,accounting for 24.07%.The age of hospitalized patients with liver transplantation ranged from 9 to 73 years old,with the majority of patients aged 40 to60 years old,accounting for 67.90%.The length of hospital stay ranged from 5 days to115 days,with 75(23.15%)patients receiving <16 days,174(53.70%)patients receiving 16-30 days,and 75(23.15%)patients receiving >30 days.Among the different medical payment methods,the largest is provincial medical insurance patients of the surveyed provinces,with a total of 100(30.86%)cases,followed by 84(25.93%)cases of urban employees’ medical insurance patients in the surveyed regions.2.From 2017 to 2021,the median of the total expenses of liver transplantation inpatients was 529636.22 yuan,the median of medical service expenses was 22175.75 yuan,the median of diagnosis expenses was 38145.66 yuan,the median of treatment expenses was 17573.22 yuan,the median of consumables expenses was 89313.67 yuan,the median of donor expenses was 217621.18 yuan,the median of drug expenses was124331.65 yuan,and the median of blood and blood products expenses was 8119.63 yuan.Among them,the total expenses of hospitalization decreased from 2017 to 2019,and increased from 2020 to 2021.3.Grey correlation analysis the showed that the highest correlation among each single inpatient expenses change from 2017 to 2021 was the donor expenses(1.000),followed by drug expenses(0.841),consumables expenses(0.802),diagnosis expenses(0.744),medical service expenses(0.729),treatment expenses(0.724),blood and blood products expenses(0.716);The analysis of the degree of the structural change showed that changes in donor expenses have the largest structural contribution to total expenses changes(42.20%)followed by the expenses of consumables(32.27%),medicine(14.21%),medical service(5.86%),diagnosis(3.21%),blood and blood products(1.62%),and treatment(0.63%).4.From 2017 to 2021,the case-based payment policy of liver transplantation actually covered 96(44.66%)patients,including 11 patients with medical insurance for urban and rural residents in the surveyed regions and cities,45 patients with medical insurance for urban employees in the surveyed regions and cities,and 40 patients with medical insurance in the surveyed regions and provinces.The median of the total expenses of patients included in the liver cancer transplantation group and the non-liver cancer and other diseases transplantation group all exceeded the payment standard.5.After the implementation of case-based payment,the median of hospitalization days of liver transplant patients was 19 days,with a reimbursement rate of 27.51%.Among them,the median of hospitalization days of patients included in the case-based payment group was 17 days,with a reimbursement rate of 29.03% and the median of hospitalization days of patients not included in the case-based payment group was 21 days,with a reimbursement rate of 25.02%.The difference-in-differences model was constructed to calculate the D-value between the pre-and post-case-based payment.The results showed that the payment for case-based payment reduced the total hospitalization expenses of liver transplant patients(β=-0.054,95%CI=-0.099 ～-0.009)and diagnosis expenses(β=-0.084,95%CI=-0.140 ～-0.028),increased the reimbursement rates for patients(β=0.072,95%CI=0.018 ～ 0.126).6.Calculate the DRG standard value of liver transplantation for surveyed hospital based on weights and rates,there is no statistically significant difference between the DRG expenses setting standard value of liver transplantation in the surveyed urban employees’ medical insurance and the previous expenses in the surveyed area;the DRG expenses setting standard value of liver transplantation in the surveyed urban and rural residents’ medical insurance in the surveyed area is lower than the previous expenses.Conclusions:1.Compared with the per capita disposable income of the residents in the surveyed areas and medical insurance reimbursement level,the medical economic burden of liver transplantation patients in the surveyed hospital is heavy.2.Donor expenses is the primary factor that affects the internal composition of liver transplantation hospitalization expenses.The proportion of drugs and consumables expenses is relatively high,and the proportion of medical service expenses and treatment expenses is relatively low.3.In the internal composition of hospitalization expenses,the changes of donor expenses,consumables expenses,drug expenses,medical service expenses and diagnosis expenses have a great impact on the total expenses structure.4.The hospitalization days is the most obvious variable influencing factor of the hospitalization expenses of liver transplantation patients.The Case-based payment policy effectively controlled the increase of hospitalization expenses of liver transplant patients and improved the reimbursement level of medical insurance patients.