Study On The Cost Of Treatment And The Influence Of Adjustment Of Medical Insurance Medicine Catalogue On Hospitalization Expenses Of Rare Diseases In Gansu Province

Objective: We explored the treatment costs of rare diseases and their distribution in different dimensions in Gansu Province in 2020,analyzed the changing trends and main influencing factors of hospitalization costs of patients with rare diseases from2015 to 2020 as well as the impact of the adjustment of the National Basic Medical Insurance Medicine Catalogue on the hospitalization costs of rare diseases.To reveal the current situation of health resource distribution and direct economic burden of patients in rare diseases,we provided effective data support for decision makers to accurately formulate health,health strategies for rare diseases,reasonably plan health resource input for rare diseases and explored measures to reduce the personal economic burden of patients with rare diseases.Methods: Based on the “A System of Health Accounts 2011”(SHA2011),according to the top-down principle,data on the Current Health Expenditure were obtained by official statistics,and apportionment factors were calculated using sample data obtained from a five-level stratified whole-group sampling.Accounting and analysis of treatment costs of rare diseases in Gansu Province from three dimensions:the population benefit,the service function,and the institutional flow.GDP deflator was used to discount the cost data.We also analyzed the direct economic burden and trends of rare disease hospitalization costs over 6 years by Dynamic Series method,Spearman Correlation Analysis.Degree of Structural Variation method was used to observe the internal composition of hospitalization costs.Nonparametric test was used to analyze One-way ANOVA.K-Means cluster analysis and Support Vector Machine model were used to analyze factors of hospitalization costs for patients with rare diseases.The changes in hospitalization costs of patients with rare diseases before and after the adjustment of the National Health Insurance Drug List in 2017 were explored by Interrupted Time Series Analysis.Results: 1.60,924,700 Yuan for treatment of rare disease in Gansu Province in2020.Neurological diseases,endocrine,nutritional and metabolic diseases,blood and blood-forming organ diseases and certain other disorders involving the immune system are among the top three rare disease types treated in Gansu Province.The top three diseases for treatment of rare diseases in Gansu Province are hemophilia,phenylketonuria and generalized myasthenia gravis,and the treatment cost of the three diseases accounted for 56.38% of the treatment cost of all patients of rare disease in Gansu Province.2.The treatment cost of male rare disease patients in Gansu Province is higher than that of female rare disease patients in 2020;the treatment cost of rare disease for people under 60 years old accounts for 82.74% of the treatment cost of the patients of rare disease population in Gansu Province,and the highest treatment costs for the population of children younger than 15 years of age.72.55% of the cost of treatment of rare disease flowed mainly to hospitals,mainly to general hospitals.Among institutional levels,the cost of treatment of rare disease in Gansu Province in 2020 flowed mainly to provincial institutions,accounting for 39.34%.3.2015-2020 average per hospitalization cost for rare diseases increased from8,704.25 yuan in 2015 to 10,521.55 yuan in 2020,with an average growth rate of3.21%.Average daily hospitalization costs rose from 999.46 yuan in 2015 to 1,309.25 yuan in 2020,an average growth rate of 1.72%.The average number of days per hospital stay increased from 10.53 days in 2015 to 11.43 days in 2020.The main factor causing changes in the structure of the average cost of hospitalization for patients with rare diseases is the cost of drugs.4.The factors influencing the cost of hospitalization for rare diseases,in order of importance,are days of hospitalization(0.365),whether surgery(0.150),whether reimbursed(0.134),whether combined(0.111),level of institution(0.065),age(0.043),whether prescribed medication(0.037),type of institution(0.035),type of disease(0.031),and drug costs as a percentage of inpatient costs(0.030).5.Out-of-pocket health payments before the list of medicines covered by the medical-insurance system in 2017 was 2921.17 yuan,after the list of medicines covered by the medical-insurance system in 2017 was 2065.88 yuan.After the policy adjustment,the personal health expenditure for rare diseases showed a significant downward trend and the average health insurance reimbursement ratio for rare diseases showed a significant upward trend.Conclusions: 1.The cost of treatment for men is higher than women,as well as the treatment costs are highest for pediatric patients younger than 15 years old.72%of treatment costs flow to hospitals,mainly general hospitals.55.77% of treatment costs flow to provincial and municipal medical institutions.2.Diseases of the nervous system,endocrine,nutritional and metabolic diseases,hematological and hematopoietic diseases,and certain other diseases involving the immune system are the main types of diseases of focus.Hemophilia,phenylketonuria and generalized myasthenia gravis are the rare diseases of focus.3.Average cost per hospitalization,average daily cost per hospitalization,and average number of days per hospitalization for rare diseases increase with year in2015-2020.The cost of drugs is the main factor that constitutes the cost of hospitalization for rare diseases.Days of hospitalization,whether surgery was performed,and whether reimbursement was available were the core influencing factors for the cost of hospitalization for rare diseases.4.Out-of-pocket health payments decline for some patients with rare diseases after the list of medicines covered by the medical-insurance system in 2017,and the effect becomes more pronounced as time increases.5.The demand for health services of rare diseases is inadequate in Gansu Province.In order to give more policy support to rare patients,the government should establish medical collaboration network of rare diseases as well as the system of tiered diagnosis and treatment.We also need to improve the multi-level medical security mechanism for rare diseases.