The Effectiveness Of Infection On The Hospitalization Cost Of Primary Acute Myeloid Leukemia Under Guangzhou Medical Insurance Policy

Objective:With the continuous innovation and development of medical technology,the aging of the national population,the application of various new special drugs and medical consumables,the increase of people’s economic income,the improvement of health care awareness,the increase of diseases caused by environmental pollution,the change of chronic disease spectrum and the "lighthouse"effect of medical insurance reimbursement,the demand for medical treatment is increasing rapidly,and the medical expenses are showing a rapid growth trend.Recently,the state,provinces and municipalities have issued policy documents to further deepen the reform of payment mode of basic medical insurance.The policy of disease score payment under the control of regional total amount implemented by Guangzhou City has not fully considered the severity of disease and complications of inpatients at different levels and hospitals in the process of formulating the disease score database.As far as the medical institutions with more complex and critical patients are concerned,the current policy of disease scoring is seriously deficient,which causes huge economic pressure on medical institutions and affects the quality of normal diagnosis and treatment services.This research combines with Guangzhou Medical Insurance Payment Policy by Disease Score,carries out cost analysis on discharged cases of a large tertiary public general hospital,finds out the departments with the most serious loss of score and the corresponding hospitalized cases,analyses the core nodes affecting the hospitalization medical expenses,investigates and studies the high-risk factors affecting the core nodes,so as to make the medical insurance agency more scientific and reasonable.Setting the corresponding disease score provides a theoretical basis.Methods:The basic data of discharged cases from January 1,2015 to December 31,2018 in a large tertiary public general hospital in Guangzhou were collected,including the types and strains of pathogenic bacteria,details of hospitalization expenses of newly treated acute myeloid leukemia patients,records of hospitalized medical records,and records of microbiological test results.The above data were sorted out and reasonably transported by Office,SPSS20.0 and other sof-tware.Univariate analysis of variance,independent sample t test,contingency correlation coefficient analysis,logistic regression analysis and other statistical methods were used for analysis.Result:Based on the payment policy of medical insurance according to disease score,preliminary analysis of the basic data on the front page of medical records of discharged cases in all clinical departments of the hospital in 2018 showed that the hematology department had the most serious loss,and the medical insurance score loss of newly treated acute myeloid leukemia was significantly higher than that of other diseases.The cost of antibiotics is the most important part of the cost of medical treatment for newly treated acute myeloid leukemia.The type of pathogenic bacteria infection has an effect on the high level of the cost of antibiotics.Compared with unknown pathogenic bacteria infection,there is no statistical difference in the cost of antibiotics for bacterial and fungal infections.The mixed infection of bacteria and fungi is a high-risk factor for the high level of the cost of antibiotics.The cost of antibiotics is high in cases of mixed infection of bacteria and fungi.The length of hospitalization has an effect on the high level of antibiotics cost.The duration of hospitalization is a high risk factor for the high level of antibiotics cost.The cost of antibiotics is high in cases of 30 days or more.Conclusions:According to the above analysis results,the following conclusions can be drawn:1.The high infection rate of newly treated acute myeloid leukemia cases,the mixed infection of bacteria and fungi,and the hospitalization days of 30 days or more are independent high-risk factors for the high cost of antibiotics for newly treated acute myeloid leukemia.2.It is suggested that medical insurance agencies should fully consider the specific high-risk infectious factors such as bacterial and fungal co-infection,hospitalization days greater than or equal to 30 days,and clinical treatment needs such as the lack of antimicrobial agents for neutrophils with fever after chemotherapy in the process of determining the disease score of disease coding suborder C92.0 acute myeloid leukemia.These factors will directly cause the cost of antimicrobial agents.Increased use will affect the level of hospitalization expenses for newly treated acute myeloid leukemia.3.It is suggested that medical insurance agencies introduce DRGs payment system as soon as possible.When grouping,more consideration should be given to clinical reality,demography,resource consumption and severity.Age,sex,secondary diagnosis,treatment methods,complications and prognosis should also be included in the grouping basis.