Analysis The Expenses And Hospitalization Of Three Couses Of Chronic Hepatitis B Patients Under Different Health Insurance Schemes

Viral hepatitis B has spread widely in China, seriously endangering the health of the people, the incidence of hepatitis B for many years has been high, hepatitis B causes heavy economic burden to patients, families, social.It has become an important public health and social problems.The project is the baseline datas part of the report "the11th Five-Year Plan" B viral hepatitis scale field epidemiology and intervention research".The subject research is the second batch of major projects. The report analysis the diagnosis treatment and medical expenses of medical institutions of Zhangqiu and Shouguang before the start of the project, which is two hepatitis B integrated control program.Compare with the municipal hospitals of the People’s Hospital in Weifang City, Shandong Province hepatitis B diagnosis and treatment of high level of infection Jinan CityHospital, and the second Hospital of Shandong University, probing into the existing problems and shortcomings. Analysis the differences of length of stay (LOS), medical expenses of hepatitis B patients under different Medicare system, and to study the influencing factors.Provide a basis for further medical reform in the future and to balance the treatment gap between the different medical insurance schemes.Main objective:Through analyzing the length of stay, antiviral therapy, medical expenses and reimbursement of chronic hepatitis B, liver cirrhosis and hepatocellular carcinoma patients in Jinan, Weifang City, the two regions under the different Medicare system research. To study the influencing factors for different hepatitis B disease in patients, to promote further reform of the health care system and to balance the treatment gap between the different medical insurance system, and promote social equity vigorously.Research methods:County hospitals of Shouguang and Zhangqiu are the project demonstration areas. Selecting better municipal hospitals from two counties as a control, extract all medical records from the hospital discharge in2009, the first diagnosis as"hepatitis B". Part of the hospital medical record numbers in2009are not enough, discharged from2008records as supplement.Acquire useful information from the medical records in accordance with pre-designed questionnaire. Questionnaire include the basic situation of the patients, the detection of serology and equipment checks during hospitalization, level of care and discharge from the outcomes,medical expenses and reimbursement so on.The data is the quantitative data analysis.Analyze the difference of length of stay (LOS), medical expenses and reimbursement for hepatitis B patients under different Medicare system.Numerical variables using mean, median to describe the bed days and medical expenses under a variety of patients with hepatitis B type with different medical insurance system. Categorical variable data uses the rate of adoption, form ratio to describe the propotional relationship of the bed charges, traditional Chinese medicine fees, Western medicine fees, treatment costs and the total hospital costs, and describes the application of the antiviral drugs.Using the Wilcoxon rank sum test to have bed days, hospital costs a statistical inference for completely randomized design of non-normal distribution of multiple samples, on different hepatitis B patients with different medical insurance system.Binary Logistic regression analyz the influencing factors of discharg outcome of different hepatitis B patients, multiple linear regression analyze the influencing factors of the cost of hospitalization, hospital bed days.Research results:1) There were significant differences in length of stay single case among chronic hepatitis B, liver cirrhosis and liver cancer patients. Urban workers’ length of stay is the highest among the urban workers, urban residents and the new rural cooperative insured persons. Average inpatient bed days of urban workers is urban residents’1.6-2.3times in different type of chronic hepatitis B,which is new rural cooperative patients’1.5-1.8times. Average inpatient bed days of urban workers are the highest of liver cirrhosis patients, which is about urban residents’1.6-4.3times.And is new rural cooperative patients’1.4-1.6times.The gap of hospital bed days is the largest between urban workers and urban residents. Inpatient bed days of urban workers are the highest of liver cancer patients, which is about urban residents’4.51times.And is about new rural cooperative patients’1.85-2.16times.2) Different type of chronic hepatitis B patients, in addition to the undivided patients, inpatient bed days of urban workers at the county level hospital are the municipal hospital’s1.26-1.88times. Inpatient bed days of municipal hospitals are higher than the county level hospitals’of new rural cooperative shceme. Inpatient bed days of urban workers insured at the county level hospitals are higher than the municipal hospital’s.While municipal hospital’s is higher of the new rural cooperative.There was not significant difference in inpatient bed days with liver cancer patients at the county level hospitals and municipal hospital patients, basic county-level hospital bed days than the municipal hospital. The inpatient bed days of at county-level hospital of urban workers are higher than the municipal hospital’s.3)①The antiviral treatment rate of urban workers is the highest in mild, severe and unclassified chronic hepatitis B. Followed by the new rural cooperative patients. The antiviral treatment rate of new rural cooperative is the highest in moderate chronic hepatitis B, followed by urban workers. The antiviral treatment rate of various types of chronic hepatitis B in municipal hospital is evidently higher than that in county-level hospital under the same medical insurance. The use of alone regular interferon and nucleoside drugs case was more common in anti-viral treatment.②The antiviral treatment rate and hepatoprotective drug use of urban worker with liver cirrhosis is higher than other medicare patients. Nucleoside antiviral drugs are widely used. Antiviral treatment rate of municipal hospital under new rural cooperative was significantly higher than the county hospital patients. Patients under the medical insurance for urban workers in addition to patients with complications, the anti-virus treatment rates of county hospital patients are all higher than the municipal hospital patients.③The antiviral treatment rate and hepatoprotective drug use of urban workers were higher than other Medicare patients with hepatocellular carcinoma. Nucleoside antiviral drugs are widely used.The antiviral treatment rate of municipal hospital was higher than that in the county hospital. In addition to the unclassified patients with hepatocellular carcinoma under new rural cooperative, the antiviral treatment rate of county hospitals is all higher.4) the improvement rate of new rural cooperative is higher in liver cirrhosis and liver cancer patients.There was higher improvement rate in urban workers of hepatitis B.5) the single hospital cost and reimbursement of urban workers are the highest in different types of chronic hepatitis B. Hospitalization costs were urban residents’1.6times, the new rural cooperative patients’1.3times. Urban workers, urban residents and the new rural cooperative reimbursement are respectively70%,45%and20%. Western medicine fees and bed costs accounted for the vast majority of hospital expenses. Hospital expenses of urban workers with liver cirrhos are much higher than other types of medical insurance. The medical expenses reimbursement of urban workers is about70%.While the reimbursemnt of new rural cooperative is about17%. The patients’reimbursement rates of urban workers with HCC are the highest (70%). Reimbursement rate is the new rural cooperative patients’3.74-4.22times. Hospital expenses are the new rural cooperative patients’1.94-2.51times, which are the urban residents4.67-5.45times.6) Different hepatitis B disease, its influencing factors are different. Medical insurance type and whether or not using antibiotics are the common influencing factors for the chronic hepatitis B, liver cirrhosis and liver cancer patients’hospital bed days and hospital costs. The outcome of the hepatitis B is no common effect of factors.Research conclusion:1) Urban workers’single cases of hospital bed days are the highest in all insured participants among Chronic, cirrhosis and liver cancer three patients with hepatitis B.2) The rate of using antiviral treatment and hepatoprotective drug in municipal hospital is higher than the patients of county hospital.The patients are with hepatitis B under different medical security system. There is no consistent trend in hospital bed days.3) Urban workers’medical expenses and reimbursement are the highest among the three patients with hepatitis B. Western medicine fees and bed charges are a major component of medical expenses.4) The influencing factors of hospital bed days and expenses of different hepatitis B patients are different.Policy recommendations:1) In the future health system reform, we should further deepen the reform and improve benefits under various medical insurance shemes, narrow the gap benefits in different medical insurance system.Build multi-level security model aming at different levels of income, set up integrated management of urban and rural health care.Balancing treatment gap in the different medical insurance systems. To draft a reasonable reimbursement rate aiming at different diseases, and effectively reduce the burden on the patient’s and promote social equity.2) Length of stay is an important factor of hospitalization expense.We should control the hospital bed days reasonably, to reduce unnecessary hospitalization.Aiming at hepatitis B, formulate clinical path, and determine the rational length of stay,so as to control medical expenses.3) Focus on the development of primary health care services, improve the diagnosis and treatment technology, and implement the different reimbursement mechanisms to different levels of hospitals, improve the reimbursement rate of county hospitals to encourage more patients to county hospitals for treatment, so as to realize split-flow of patients.4) Bring more hepatitis B drugs in the directory of health care, and increase the reimbursement rate appropriatly, in order to facilitate patients with timely and effective treatment to slow disease progression, and improve patients’health.5) Emphasis on the prevention and control strategies of hepatitis B to control disease risk factors.As early as possible proceeds effective treatment and prevention, timely and effectively conduct antiviral treatment, to inhibit the viral replication, prevent or reduce the proportion of disease prognosis. Strengthening self-monitoring, especially in the early of disease, strengthening the patient’s self-management, delay or prevent to cirrhosis and liver cancer progression.6) Implement the national essential drug system effectively, and carry out the drug collective bidding to reduce intermediate links, to reduce procurement costs. Implement the drug sales of zero difference and alleviate the medical burden of the patient’s;...