The Impact Of COVID-19 On The Inpatient Expenses Of Different Levels Of Hospitals In Gansu Province

Objective:By analyzing the characteristics of hospitalization expenses of inpatients in a provincial,municipal and county-level non COVID-19 general hospital designated to receive patients with COVID-19 infection in Gansu Province from 2019 to 2021,we can understand the impact of COVID-19 epidemic on hospitalization expenses of inpatients in hospitals at different levels.Through the analysis of the two models,we can provide methods for reference for future research on similar problems,and also provide basis for relevant departments.Methods:Collect the inpatients of a provincial,municipal and county-level non COVID-19 infection patient in a designated tertiary general hospital in Gansu Province from2019 to 2021,import the collected case information into Excel 2019 to establish a database,eliminate the missing data according to the inclusion criteria,apply SPSS 21.0 to conduct general description,variance analysis,correlation analysis and recursive system model analysis of the data,and apply Amos 27.0 to analyze the data using structural equation model.Results:Compared with 2019 and 2021,the total number of inpatients in provincial hospitals in 2020 decreased by nearly 15.1% and 6.4% respectively;the total number of inpatients in municipal hospitals decreased by nearly 9.1% and 17.6% respectively;The total number of inpatients in county-level hospitals decreased by nearly 23.4% and 7.7%.The average number of inpatients in provincial hospitals in 2020 is higher than that in 2019 and2021,the average number of inpatients in municipal hospitals is lower than that in 2019 and2021,and the average number of inpatients in county hospitals is higher than that in 2019 and lower than that in 2021.The average hospitalization cost of provincial hospitals in 2020 is higher than that in 2019 and 2021,and the average total hospitalization cost of inpatients in municipal and county hospitals is higher than that in 2019 and lower than that in 2021.The composition of hospitalization expenses of inpatients in different levels of hospitals is also different.Provincial hospitals mainly pay for diagnosis,treatment and examination;Municipal and county-level hospitals mainly pay for drugs.No matter each year,the hospitalization expenses of inpatients were provincial>municipal>county,and the hospitalization expenses increased with the increase of hospitalization days(P<0.05).The results of the recursive system model and the structural equation model show that the main influencing factors of the hospitalization expenses are the length of stay,gender,age,the hospital level,year of admission and the type of disease.The effects of each influencing factor on the hospitalization expenses are also different,and the structural equation model also shows that there is a correlation among the variables.Conclusions:By analyzing the hospitalization expenses of provincial,municipal,and county-level hospitals,it was found that in 2021,both the hospitalization expenses of municipal and county-level hospitals increased,surpassing 2020,while the hospitalization expenses of provincial-level hospitals decreased.After the weakening of prevention and control measures in 2021,although the number of inpatients in provincial-level hospitals increased,both the total hospitalization expenses and the composition of various expenses did not return to their previous levels.In order to reduce the impact of COVID-19 on hospitals at all levels and speed up the hospital’s resumption of work,we should make full use of the telephone or online medical platform in the post epidemic era,which can not only avoid excessive concentration of medical needs to superior hospitals,resulting in uneven distribution and waste of medical resources,but also better promote hierarchical diagnosis and treatment;It can also reduce overdiagnosis and treatment to a certain extent,reducing the economic burden on patients.There are also significant differences in the composition of hospitalization expenses among provincial,municipal,and county-level hospitals.Provincial hospitals have a relatively high proportion of diagnosis,treatment,and examination fees,while municipal and county-level hospitals have the highest proportion of drug expenses.By analyzing the influencing factors of hospitalization expenses through two models,it was found that different factors have direct and/or indirect effects on hospitalization expenses.The results of the two models are basically consistent,while the structural equation model can better reflect the effects between various influencing factors,which has certain advantages and accuracy.