Study On The Influencing Factors Of Hospital Single Disease Cost Under Clinical Pathway

With the development of medical technology and the aggravation of population aging,China's medical expenses are rising year by year,which brings great pressure to the smooth operation of the medical insurance fund.On Dec 1,2017,Health insurance payment reform has been implemented in hospitals in zhejiang province.Under the new health care reform policy influence,the hospital's economic operation faces huge challenges.On the research of the cost of single diseases must be carried out as soon as possible,to explore the influence factors of cost of single diseases,completes the cost management and control of single diseases,reduce operating costs,improve the level of hospital performance.This study aiming at single diseases fee after medical institutions for medical treatment of surplus decline,cost control difficult problems,selecting 1007 cases in a provincial hospital as the research sample,through cost accounting method measuring the medical cost of single diseases.SPSS 20.0 and SPSS MODELER18.0 software were used to fit the path model and CHAID decision tree model to analyze the influencing factors of hospital single disease medical cost under clinical pathway.Through the calculation of the medical cost in sample hospital,it is found that the executive income of the medical technology department is much higher than the department cost,while the clinical department is on the contrary.Through the analysis of the cost structure of single diseases,it was found that the cost of medical consumables,drugs,laboratory tests and examinations accounts for more than 60% of the cost of diseases,while the cost of medical services reflecting the labor value of medical personnel accounts for less than 40%.It reflects the irrationality of the price of medical services.The medical fees for inspection and inspection items are relatively high,while the medical fees for operation,nursing,treatment and other items reflecting the value of medical personnel's services are relatively low.The results of the path model indicate that the average length of hospital stay can directly affect the cost of disease species,The influence of the proportion of medical consumables on the cost of disease species is two-sided.On the one hand,this variable directly positively affects the cost of single disease species.On the other hand,the average length of hospital stay indirectly negatively affects the disease species cost.In terms of the overall effect,the high proportion of medical consumables will increase the medical cost of diseases.The proportion of drug cost directly affects the medical cost of single disease.The formalized management of clinical pathway has a direct negative effect on the cost of single disease,but has no effect on the average annual hospital stay.In addition,disease type is the most important factor influencing the medical cost of single disease type in hospital.Gender variables of demographic and sociological factors can directly and indirectly negatively affect the cost of single disease.The CHAID decision tree model was used to determine the case cost combination under the settlement mode of 8 single disease species,the number of exceeding the standard cases in each group can be obtained.The prediction accuracy of the model exceeded 80%.The classification rules of case cost combination can effectively guide hospitals to develop reasonable disease cost control plans.According to the results of the empirical study,this study developed control strategies from the management level of medical institutions and the government policy formulation level on the controllable influencing factors of the medical cost of single disease in the clinical pathway of hospitals.This study enriches previous scholars' research methods on influencing factors of diseasespecies cost and medical cost control of disease species,and provides new research ideas.It provides theoretical basis and method support for the establishment of reasonable single-disease settlement standards for the medical insurance departments and the formulation of financial subsidy policies for medical institutions by the financial departments.It is beneficial to improve the management theory of total hospital cost accounting and provide reference for constructing the method system of hospital cost accounting based on disease species cost accounting.Through the analysis of the influencing factors of the medical cost of the single disease in the clinical pathway of the hospital,this study provides a scientific basis for the hospital managers to formulate the cost control plan and achieve accurate management.Through the formulation of the standard disease species cost based on clinical pathway,it is beneficial for hospitals to control the cost,improve the performance level.It provides pricing reference for the establishment of reasonable negotiation mechanism between the medical institutions and the medical insurance department,and provides data support for the establishment of settlement standard for the medical insurance department,which is conducive to the implementation of quota settlement policy for single disease.Through the study of disease cost control strategies from the perspectives of the government and the hospital,it is beneficial to restrain the growth of medical cost of disease,reduce the burden of medical treatment for patients,and save limited medical resources.