Analysis Of Factors Influencing Medical Inpatient Costs In The Context Of Medical Insurance Payment Reform

Purpose of the StudyThe purpose of this study is to investigate the changes in hospitalization costs before and after the implementation of the payment by disease system,and further analyze the mechanism of the effect of medical insurance payment method reform on the control of medical hospitalization costs through empirical tests,so as to provide reference for relevant studies on reducing medical hospitalization costs and improving the quality of medical services.It also measures the price payment standards for medical services under clinical pathway management,and strengthens the policy linkage between DRG payment reform and clinical pathway management to ensure that DRG policies can be implemented smoothly.According to the data results of the Ministry of Finance’s Fiscal Revenue and Expenditure in 2022,the expenditure on healthcare in 2022 was RMB 225.42 billion,an increase of 17.80 percentage points compared to last year’s data,partly due to the impact brought by the epidemic,and partly reflecting the very obvious unreasonable increase in current healthcare costs.In recent years,the morbidity and mortality rates of cerebral infarction disease and chronic obstructive pulmonary disease(COPD)are increasing and have become a global health crisis.Therefore,taking these two diseases as examples,this paper studies the changes in hospitalisation costs before and after the implementation of the payment-by-category system and explores its internal transmission mechanism for controlling medical costs,which can effectively guide medical decisions and reduce costs.It is an important reference for studies related to controlling unfavourable inpatient medical costs of chronic non-communicable diseases such as cerebral infarction and chronic obstructive pulmonary disease in Jiangxi Province and promoting the reform of the payment method of medical insurance.Research methods and contentThrough literature research and empirical analysis,we studied the basic conditions of patients and the structure of hospitalization costs,measured the payment standards of medical service items for two types of diseases according to clinical pathways,and further analyzed the mechanism of the role of medical insurance payment reform on medical hospitalization cost control through empirical tests.The main contents include the following:(1)Firstly,the basic situation and hospitalisation cost structure of patients with the two diseases are analysed.The general statistical analysis method was used to describe the basic information of the patients and to analyse the correlation between the average cost of hospitalisation and the number of days in hospital for the two diseases,and to explore the changes in the cost of treatment,drugs and consumables before and after the implementation of the payment by disease system;(2)secondly,the price payment standards for medical services for the two diseases under different payment standards were measured based on clinical pathways.This study uses the medical service item superposition method to calculate the cost of the disease based on the clinical pathway and the treatment plan of the two diseases,so as to achieve scientific control of the cost of the disease,improve the quality and efficiency of medical services,and provide strong support for the reform of China’s health insurance payment method.(3)Finally,an empirical study on the impact mechanism of health insurance payment reform on the medical hospitalization costs of two diseases.Non-parametric tests were used to explore the single factor analysis of patients’ basic conditions and disease characteristics on hospitalization costs under different health insurance payment methods,and further OLS regression models and quantile regression models were used to conduct multi-factor regression analysis to explore the factors influencing the hospitalization costs of patients with chronic obstructive pulmonary disease and cerebral infarction under two different health insurance payment methods,namely the per-patient group and the per-item group.Findings of the study(1)After the implementation of the per-patient payment system,the number of consultations,average per-visit costs and total costs of patients with cerebral infarction and chronic obstructive pulmonary disease all changed.The average inpatient sub-cost for cerebral infarction patients decreased from RMB10,046.92 to RMB9,120.17 after the implementation of the policy,with an increase in the number of visits and an increase in the total inpatient cost.The average cost of hospitalisation for patients with chronic obstructive pulmonary disease decreased from RMB7,001.78 to RMB6,674.70 after the implementation of the payment-by-category system,and at the same time,the number of visits and the total cost of hospitalisation both tended to decrease.(3)Clinical pathway management plays a good role in controlling hospitalization costs,but the management process needs to be further optimized;(4)Age,complications,days of hospitalization,type of medical insurance and hospital level will have an impact on hospitalization costs.Research conclusions and recommendationsThe conclusions of this study include the following aspects:(1)the implementation of the payment-by-category system has reduced the average hospitalisation cost of patients with cerebral infarction and chronic obstructive pulmonary disease,but the internal structure of hospitalisation cost is still unreasonable and needs to be further optimised;(2)the number of hospitalisation days has been shortened after the implementation of the payment-by-category system,which has achieved the purpose of reducing hospitalisation cost;(3)clinical pathway management can standardise the treatment process and achieve the purpose of reducing hospitalisation cost.(3)Clinical pathway management can standardize the treatment process and achieve the purpose of reducing hospitalization costs,but the management process needs to be refined and the quality of filling in information on the first page of the case is poor,all of which restrict the further development of the DRG payment method.In response to these findings,the following recommendations are made:(1)future research should further optimise the internal structure of inpatient costs;(2)strengthen the management of quality information on the first page of cases and further refine the clinical pathway management process;(3)give play to the guiding role of medical insurance policies and promote the policy linkage mechanism between clinical pathway management and the payment system by disease type;(4)in addition,it is also necessary to strengthen the preventive care of chronic non-communicable diseases In addition,we should also strengthen preventive care for chronic non-communicable diseases,actively promote tertiary prevention,and reduce the unreasonable increase in medical hospitalization costs at source.