Study On The Current Situation,Changing Trend And Influencing Factors Of Schizophrenia Treatment Costs In Gansu Province

Objective To explore the distribution of schizophrenia treatment costs and their distribution in different dimensions in Gansu Province in 2020.To analyze the changing trend of patient’s hospitalization cost and the main influencing factors from 2015 to2020.To elucidate the current situation of health resource distribution and the direct economic burden of schizophrenia patients.Ultimately,it can provide a theoretical basis for government departments to formulate relevant health policies,reasonably allocate medical resources,and reduce patients’economic burden level.Methods The data of total treatment cost in this study were from official statistics such as Health Financial Annual Reports and Health Statistical Yearbooks.Using a multi-stage stratified cluster sampling method,96,036 patients with schizophrenia from930 medical and health institutions in Gansu Province were selected as the study population.And information on their general demographic characteristics,medical costs,and health insurance reimbursement was obtained from the medical information system to form a schizophrenia case database.Based on the System of Health Accounts2011(SHA 2011),the top-down apportionment method was used to account for the treatment costs of schizophrenia in Gansu Province in 2020 using Stata 17.0.The rank sum test and Spearman rank correlation were used for univariate analysis of hospitalization costs of schizophrenia patients.Dynamic Series Analysis and Degree of Structure Variation Analysis methods were used to study the trend of hospitalization costs.Multiple Linear Regression,Random Forest,and BP Neural Network models were used to analyze the influencing factors of the costs.Results 1.The total treatment cost of schizophrenia in Gansu Province in 2020was 369.91 million yuan,accounting for 0.66%of the treatment cost of all diseases in Gansu Province.The per capita treatment cost of patients was 4,970.48 yuan.The total outpatient treatment cost was 105.62 million yuan(28.55%),and the inpatient cost was264.29 million yuan(71.45%).The treatment costs for male and female patients were211.48 million yuan(57.17%)and 158.43 million yuan(42.83%),respectively.The age distribution of schizophrenia treatment costs was bimodal,with the first peak was 30-34 years old and the second peak was 45-49 years old.Among patients with defined disease subtypes,paranoid schizophrenia treatment cost was the highest(55.77 million yuan,15.07%).90.13%of the treatment costs were used in specialized hospitals,and7.35%were used in basic-level healthcare institutions.In terms of institutional level,87.18%of the costs flowed to municipal medical and health institutions.2.The average length of stay of schizophrenia inpatients was 51.14±41.98 days in Gansu Province from 2015 to 2020.The average hospitalization cost was 10,893.76yuan,the average out-of-pocket cost was 3,558.43 yuan,and the average daily hospitalization cost was 283.83 yuan.Treatment costs accounted for the highest percentage of the average hospitalization cost,and bed and nursing fees followed.Medication costs contributed the most to the structural change in hospitalization costs.From 2015 to 2018,the average hospitalization cost decreased from 12,431.66 yuan to9,267.46 yuan,and then gradually increased to 12,265.28 yuan in 2020.The average out-of-pocket cost decreased from 6,423.08 yuan to 1,954.37 yuan during the six-year period,with the average growth rate of-21.18%.The average daily hospitalization cost decreased from 281.70 yuan to 272.96 yuan,with the average growth rate of-0.63%.3.The results of the analysis of influencing factors using Multiple Linear Regression,Random Forest,and BP Neural Network models showed that the primary influencing factor of hospitalization costs for schizophrenia patients was the length of stay in the hospital,followed by the proportion of medication costs,disease subtype,and institutional level.The results of univariate analysis showed that the hospitalization cost was positively correlated with the length of stay(r_s=0.682,P<0.001).In terms of model performance,both RMSE and MAE were ranked as Multiple Linear Regression>BP Neural Network>Random Forest.And R~2 was ranked as Random Forest>BP Neural Network>Multiple Linear Regression.Conclusion 1.The cost of schizophrenia treatment in Gansu Province was higher for males than females,and higher for inpatients than outpatients.It has a bimodal distribution in terms of age,and the costs mainly flowed to specialized hospitals and municipal medical and health institutions.Overall,the allocation of mental health resources in Gansu Province needs to be further optimized.2.The average hospitalization cost and the average out-of-pocket cost per capita of schizophrenia in Gansu Province showed an overall decreasing trend and rebounded in 2020.Among the various itemized costs,treatment costs,and bed and nursing fees account for a relatively high proportion.The average hospitalization cost of patients is at a high level compared with other chronic non-communicable diseases.3.The length of stay in the hospital,proportion of medication costs,disease subtype,and level of the medical institution were the main factors influencing the average hospitalization cost of schizophrenia patients.In the study of factors influencing hospitalization costs,the model performance of Random Forest was slightly better than that of BP Neural Network,and both were significantly better than Multiple Linear Regression.4.The length of stay in the hospital for schizophrenia patients in Gansu Province is relatively long.In order to further reduce the level of economic burden of the disease,the length of stay for inpatients should be reasonably reduced in the future.The treatment level and efficiency of medical institutions should be improved.The level of community management of schizophrenia should be enhanced.And the transformation of the management model of schizophrenia should be promoted.