| BackgroundIn the past 30 years, China has been experiencing the rapid development of economy, meanwhile with considerable progresses in the medical care system. However, "Hard to get medical care, expensive to get medical care" is still a common problem in China. China has attached great attentions to the medical care system, has promoted the health system reform, the establishment of medical security system. Since 1998, China has launched the national Medical insurance for urban workers. In 2003, China then set up gradually new rural cooperative medical insurance system; Last, China government carried out the Urban Residents Basic Medical Insurance for the unemployed in 2007. Now, China has these three typical medical insurance systems which together almost cover all residents. We investigated the hospital cost and discussed these three different types of insurance system in China.ObjectivesWe aimed to analyze the inpatient hospital expense for breast cancer patients from a top hospital located in Northern Anhui province whose expense were covered by the above three diverse medical insurance systems, and then discuss the coverage of these three insurance systems.MethodsWe categorized the patients into three different groups based on which medical insurance system they had. We extracted the total hospital cost and the expense item details for each breast cancer patients. We analyzed and compared the cost under the three different groups through literature review, quantitative and qualitative investigations.Results1. The majority of cost in all three groups patients was for of Chinese and Western medicine (48.9%～51.3%), which was roughly half of the total cost. It was followed by the examination fee (12.1%～12.7%), the cost of treatment (11.6%～ 12.8%), surgery (10%～10.4%), anesthetic fee (4.1%～5.2%), cost of Chinese medicine and others.2. There were significant statistical differences among the three groups in the total inpatient hospital cost (P<0.000), examination fee (P<0.021), cost of treatment (P<0.000), Western medicine fee (P<0.000), Chinese medicine fee (P<0.003), and anesthetic fee(P<0.016). None significant difference was observed in the surgery fee (P=0.148). The average total inpatient hospital cost were 15781.6 RMB (Medical insurance for urban workers Group),16474.2 RMB (Urban Residents Basic Medical Insurance Group) and 13606.2 RMB (new rural cooperative medical insurance system Group). For the three groups, the average treatment fees were 1962.0 RMB, 2113.1 RMB and 1575.7 RMB respectively. For the western medicine fee:the average values in new rural cooperative medical insurance system (8088.2 RMB) and Urban Residents Basic Medical Insurance Group (8146.2 RMB) were both significantly higher than that in the new rural cooperative medical insurance system Group (6653.4 RMB).3. There was none significant difference among the three diverse medical insurance groups (F=1.702, P=0.183). However, a significant difference in the average cost per day was observed (F=16.543, P=0.000). It was shown that the average cost per day was 1142.6 RMB,1111 RMB and 953.6 RMB for Medical insurance for urban workers Group, Urban Residents Basic Medical Insurance Group and new rural cooperative medical insurance system Group respectively. The difference was possibly related to the expense capacity of urban residents and a higher proportion of reimbursement for urban workers.4. The total cost per time was 15781.6 RMB,16474.2 RMB and 13606.2 RMB for Medical insurance for urban workers Group, Urban Residents Basic Medical Insurance Group and new rural cooperative medical insurance system Group respectively. The difference was statistical significant (P<0.000). In addition, the difference of average compensation per time was significant too (P<0.000). That value for new rural cooperative medical insurance system Group was lowest (6093.8 RMB), while the values for Medical insurance for urban workers Group, Urban Residents Basic Medical Insurance Group were 11828.9 RMB and 8730.8 RMB. The average payment by him/herself per time was significant different (P<0.000) among the three groups. The payment by him/herself per time was 7743.4 RMB,7512.5 RMB and 3952.6 RMB for Urban Residents Basic Medical Insurance Group, new rural cooperative medical insurance system Group and Medical insurance for urban workers Group respectively. The actual compensation rate for Medical insurance for urban workers Group, Urban Residents Basic Medical Insurance Group and new rural cooperative medical insurance system Group was 44.8%, which was the lowest. And the average compensation rate for the other two groups were 54%(Urban Residents Basic Medical Insurance Group) and 75%(Medical insurance for urban workers Group). The difference was significant (P<0.000). This may be due to excessive use of the pharmaceutical, medical examination, treatment and otherConclusions1. The health insurance administrations and the hospitals have to monitor the rationality in the cost of Residents Basic Medical Insurance and Medical insurance for urban workers Group, in order to control the constitutive increase of cost.2. It has to promote the value of medical service supplier.3. The government should increase the financial investment and expand the coverage in new rural cooperative medical system. In the other hand we have to improve the payment form and promote the level of medical service in Residents Basic Medical Insurance and new rural cooperative medical insurance system.4. It is noted to strengthen the management of medical insurance, explore diverse the patterns of raise and pay, then improve the medical insurance service which is strongly believe to benefit the patients. |
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