Research On Costs And Influencing Factors Of Cerebral Infarction Patients In Public Hospitals In Gansu Province

Objective: Based on the study of hospitalization costs data of cerebral infarction patients in public hospitals in Gansu Province,this study aims to analyze the total amount and composition of hospitalization costs of cerebral infarction patients,construct the recursive system model to explore the influencing factors and influencing paths of hospitalization costs,and provide a basis for health-related departments to formulate cerebral infarction cost control strategies,optimize the structure of hospitalization costs and reduce the economic burden of medical costs payers.Method: The first page medical record data of cerebral infarction patients in all public hospitals in Gansu Province from 2016 to 2020 were included,and the Epi Data3.1 medical record database was established.Taking 2020 as the base year,the hospitalization costs and individual costs from 2016 to 2019 were discounted.Descriptive statistical method was used to analyze the hospitalization costs of cerebral infarction patients.Structural variation analysis method was used to analyze the internal composition and change trend of hospitalization costs.Up Set diagram was used to analyze the comorbidity mode and costs.The recursive system model was constructed to analyze the endogenous and exogenous influencing factors of hospitalization costs of cerebral infarction,and the path analysis method was used to explore the influencing path and effect of each influencing factor.Epi Data 3.1 software was used to collate and proofread the database.SPSS26.0 and R4.04 software were used to analyze the data of hospitalization costs Visio2021.0 and Amos24.0 software were used to draw the path of influencing factors.Results: A total of 210450 cerebral infarction patients were included in this study.From 2016 to 2020,the number of cerebral infarction patients increased year by year and the trend of younger patients was obvious.The per capita hospitalization cost of cerebral infarction patients was 8595.46 yuan,and the hospitalization costs showed a downward trend.The average hospitalization cost of males was higher than females,and there are differences in hospitalization costs based on different genders(Z=-50.568,P<0.001);the age group over 80 years old had the highest hospitalization costs,which was 16058.40 yuan,and the hospitalization costs increased with age(H=2825.600,P<0.001).The average hospitalization cost of tertiary hospitals was the highest,which was 11224.50 yuan.There were differences in hospitalization costs based on different hospital levels(H=56137.246,P<0.001).The average hospitalization cost of the selfpayment method was 11920.66 yuan,Urban resident basic medical insurance was10189.38 yuan.There were differences in hospitalization costs based on different medical insurance payment methods(H=19245.247,P<0.001).From the analysis of the structural changes of hospitalization costs,drug costs(35.93%),diagnosis costs(27.62%)and treatment costs(14.00%)were the main components of hospitalization costs.From 2016 to 2020,the drug costs decreased year by year,and the proportion of drugs decreased from 47.39 % to 32.16 %.The drug costs showed a negative change in the trend of change,and the treatment costs and diagnosis costs showed a positive change.The structural contribution rate of drug costs was the highest(47.92%),followed by diagnosis costs(14.22%),medical service costs(11.67%),consumables costs(10.73%)and treatment costs(8.50%).Comorbidity affects the hospitalization costs of cerebral infarction patients,83.22%of cerebral infarction patients had comorbidities in this study.The risk of hypertension combined with cerebral infarction was the highest.The average hospitalization cost of cerebral infarction patients without comorbidity was the lowest,which was 7656.89 yuan.The hospitalization costs of cerebral infarction combined with tumor(13548.40yuan),chronic lung disease(11172.26 yuan)and kidney disease(9981.28 yuan)were relatively high.There were differences in the hospitalization costs of cerebral infarction patients based on different chronic disease categories and combinations of comorbidity,and the number of comorbidities of cerebral infarction increased,and the hospitalization costs increased accordingly(H=4377.649,P<0.001).In this study,the influencing factors of hospitalization costs of cerebral infarction patients were analyzed.The recursive system model showed that the hospital days was the endogenous variable that directly affected the hospitalization costs.Exogenous variables such as comorbidity,hospital level,surgery,admission pathway,age,and medical payment method indirectly affected the hospitalization costs by affecting the hospital days.According to the results of pathway analysis,the total effect values of the top five influencing factors of hospitalization cost of cerebral infarction patients were drug cost(0.662),hospital days(0.232),tertiary hospital(0.211),surgery(0.201),and outpatient(-0.108).Conclusion: The hospitalization costs of cerebral infarction patients are relatively high in Gansu Province.Reducing the proportion of drugs and reasonably reducing the hospital days are the key to reduce the hospitalization costs of cerebral infarction patients.Health-related departments should constantly improve the internal composition of hospitalization costs,optimize the clinical pathway,the hierarchical diagnosis and treatment system of cerebral infarction,and improve the coverage and reimbursement ratio of medical insurance.At the same time,it is necessary to strengthen the management of comorbidity of cerebral infarction,screen out the direct and indirect influencing factors of hospitalization costs of cerebral infarction,and adopt targeted cost control strategies to reduce the hospitalization costs of cerebral infarction patients.