The Researchof Effect On Control Over Single-disease Charge In Medical Insurance Of Onegrade-A Tertiary Hospital In Shenyang

Objective:The key points and challenges in medical system reform is to solve the difficulties for citizens getting medical services by refraining the medical charge from rising rapidly.Presently,in most countries of the world,fast rise in medical charge could be restrained through reform in payment methods of medical insurance.Since medical insurance system has been implemented in our country,researchers are all committed to controlling the medical charge by means of reformation in payment system.Quota Settlement method based on single disease is a type of payment system built on DRGs-PPS payment methods in foreign countries combined with China own practical and medical conditions.In this research,by analyzing the data in fees of inpatient and average length of staysfrom 5 different disease in accord with single disease characteristics,effectiveness of single-disease payment method for refraining rapid increase in medical care charge and direction of medical insurance reform is studied in this paper.Methods: By adopting retrospective studies,group data extracted from 5 types of single-disease settlement in connection with medical insurance patients from 2012 to 2016 in medical information system from one Grade-A Tertiary Hospital in Shenyang,named as Group A,including 10,962 pieces of data,comparison with non-single-disease patients' payment data of same type disease as reference,marked as Group B,consisting of 12,242 pieces of data.The five single-diseaserespectively are hip replacement,laparoscopic treatment of cholecystolithiasis,laparoscopic myomectomy,lung cancer surgery,unilateral intraocular lens replacement.All the data are input into Excel and imported,processed by SPSS 22.0in statistical method.All these data of from 5 different diseases,regarding fees of inpatient and average length of stays,are descripted by percentages,means,standard deviations and constituent ratioof statistical method,and analyzed by single factor linear regression and multifactor linear mixing model.Results:Medicine cost and medical marterial of five types disease in this studydominatea bigger proportion.Based on the analysis of medical cost increasing speed and trend,except Group B of hip replacement,all other groups' medical costsare on the rise.Through T-test in the medical cost of both group A and group B in 5 types diseases,P values are all less than 0.05,in details,hip replacement(P=0.02),laparoscopic treatment of cholecystolithiasis(P<0.001)?laparoscopic myomectomy(P<0.001)?lung cancer surgery(P<0.001)?unilateral intraocular lens replacement(P=0.007).Through T-testin the average length of stays,among the results,P values in hip replacement(P =0.612)and laparoscopic treatment of cholecystolithiasis(P =0.353)are more than 0.05,other 3 P values in laparoscopic myomectomy(P=0.044)?Lung cancer surgery(P=0.002)?unilateral intraocular lens replacement(P =0.041)are less than 0.05.By multiple linear regression analysis in themedical costs,P values are less than 0.05,in details,payment method(P<0.001),gender(P<0.001),age(P<0.001),length of stay(P<0.001)and disease type(P<0.001).By multiple linear regression analysis in the lengths of stay,only P value of payment method(P =0.108)is more than 0.05,the others are less than 0.05,in details,gender(P<0.001),age(P<0.001),length of stay(P<0.001)and disease type(P<0.001).Conclusions:Single-diseasesettlement could effectively refrain medical charge from rising,relieve the patients' burden and save medical insurance fee.But it could not availably reduce the average length of stays.In further reform of medical insurance system in our country,on the base of enlarging the scope for single-disease settlement,the study suggests to make further efforts to adopt Multivariate mixed payment and DRG-PPS,in the meantime to improve clinical pathway,day-care unit and the two-way referral system.