Objective To systematically review the impact of Beijing's comprehensive reform of medical consumption linkage on medical expenses, hospital services, and hospital income. Methods Databases including CNKI, WanFang Data, VIP, CBM, PubMed, and Web of Science were searched to collect empirical research on evaluating the impact of Beijing's comprehensive reform of medical consumption linkage on patient medical expenses and hospital operation (service volume and income structure) from June 15th, 2019 to August 15th, 2021. A descriptive analysis was performed after two reviewers independently screened the literature and extracted data. Results A total of 23 studies were included, and most of them found a relatively small change in the average outpatient and emergency medical expenses after the reform. However, the average inpatient expenses in some hospitals showed an increasing trend; the service volume of most hospitals increased slightly, and the income structure was optimized (e.g., surgery and other medical technology services revenue and its proportion increased). Conclusion The comprehensive reform of the medical consumption linkage in Beijing is the practice of deepening the reform of the medical service price mechanism. Based on the summary of the reform effect, it is recommended to further improve the price mechanism, improve service quality, and promote hierarchical diagnosis and treatment.
ObjectiveTo predict the total hospitalization expenses of bronchopneumonia inpatients in a tertiay hospital of Sichuan Province through BP neural network and support vector machine models, and analyze the influencing factors.MethodsThe home page information of 749 cases of bronchopneumonia discharged from a tertiay hospital of Sichuan Province in 2017 was collected and compiled. The BP neural network model and the support vector machine model were simulated by SPSS 20.0 and Clementine softwares respectively to predict the total hospitalization expenses and analyze the influencing factors.ResultsThe accuracy rate of the BP neural network model in predicting the total hospitalization expenses was 81.2%, and the top three influencing factors and their importances were length of hospital stay (0.477), age (0.154), and discharge department (0.083). The accuracy rate of the support vector machine model in predicting the total hospitalization expenses was 93.4%, and the top three influencing factors and their importances were length of hospital stay (0.215), age (0.196), and marital status (0.172), but after stratified analysis by Mantel-Haenszel method, the correlation between marital status and total hospitalization expenses was not statistically significant (χ2=0.137, P=0.711).ConclusionsThe BP neural network model and the support vector machine model can be applied to predicting the total hospitalization expenses and analyzing the influencing factors of patients with bronchopneumonia. In this study, the prediction effect of the support vector machine is better than that of the BP neural network model. Length of hospital stay is an important influencing factor of total hospitalization expenses of bronchopneumonia patients, so shortening the length of hospital stay can significantly lighten the economic burden of these patients.
Objective To investigate constitution and costs of inpatients with circulation system diseases in Karamay Central Hospital in 2014 and provide baseline data for further evidence-based pharmacy studies of circulation system single disease. Methods The information of drug use and expenditure of circulation system diseases were collected from the hospital information system (HIS). We analyzed the data of frequency, constituent ratio and cumulative frequency by using Excel 2007 software. Results A total of 2 898 inpatients with circulation system diseases were included. The top three diseases were cerebral infarction, angina and hypertension. The cerebral infarction and coronary heart disease accounted for the largest proportion in the cost. The top one disease of total hospitalization cost, drug expense per capita and inspection cost per capita was cerebral infraction. Conclusion Based on the above results, cerebral infraction and angina were selected as the evidence-based pharmacy study goal of single disease.
Objective To analyze the costs of emergency medication in the West China Hospital within one month after Lushan earthquake based on actual medication of the victims’ disease spectrum. Methods We collected emergency medication data as evaluation index in the West China Hospital within one month after Lushan earthquake, including daily cost, cumulative percentage of pharmacology category, average cost per day/person, average cost per day/person when DUI=1, difference between average cost per day /person, and average cost per day/person when DUI=1, etc. Then, we input data using Excel software for statistically analyzing the costs of emergency medication within one month after the earthquake. Results During one month after the earthquake, the costs changed consistently with the number of victims, which implied the change of costs was rational. Injuries were classified into 6 categories and 12 kinds according to ICD-10. The costs of medication accounted for 71% of the total costs. Six kinds of illness accounted for 21%. Medication for injuries was classified into 3 categories and 18 kinds; average cost per day was 186.87 yuan and average cost per person was 1 702.70 yuan. Medication for illness was classified into 5 categories and 28 kinds; average cost per day was 38.96 yuan and average cost per person was 185.13 yuan. The mean value of average cost per day/person of injection was 14.52/5.08 times more than that of non-injection. Meanwhile, the mean value of average cost per day/person of imported medication was 7.10/5.28 times more than that of domestic medication. Conclusion The factors that impact the medication costs include: a) disease burden and traumatic conditions of the sick and wound; b) administration pathway (injection vs. non-injection); c) imported or domestic medication; and d) the rationality of taking DUI as evaluation index. When DUIgt;1, injection through the vein and imported medication take a larger share which increase the costs of medication. Emergency rescue package should mainly prepare for the injury. In order to ensure the timely, safe and effective medication, injection should be given priority to. We also should take into consideration crash-resistance/anti-quake package, reasonable dosage, convenience-to-use of drugs as well as the needs of the illness.
ObjectiveTo analyze the perioperative outcome of consecutive 1 000 patients undergoing robotic lung resection and summarize surgical experience.MethodsWe retrospectively reviewed the clinical data of 1 000 patients undergoing robotic lung resection between May 2009 and June 2018 in Shanghai Lung Tumor Clinical Medical Center. Robotic lobectomy was compared with traditional VATS over the same period using a propensity-matched analysis. There were 327 males and 673 females at average age of 56.21±11.33 years. Lobectomy was performed in 866 patients (11 bilobectomy included), sublobar resection was performed in 129 patients, sleeve lobectomy was performed in the remaining 5 patients. Pathology was as follows: adenocarcinoma in 875 patients, squamous carcinoma in 52 patients, benign tumors in 73 patients. 90.5% of the primary lung cancer were in stage Ⅰ.ResultsThe mean operative time was 90.31±19.70 min; 95.70% of patients’ estimated blood loss was less than 100 ml. Conversion rate to thoracotomy was 0.90% (9 patients) . The average lymph node station and count harvested was 5.59±1.36 and 9.60±3.21 respectively. The mean volume of chest tube drainage on the first postoperative day was 229.19±131.67 ml. Median chest tube time was 3.85±1.43 d. There was 1 in-hospital death due to pulmonary embolism. A total of 189 patients had postoperative complications (18.90%) whose majority was postoperative air leak more than 5 days. The mean overall hospital costs was 92 710.53±12 367.23 Yuan. Compared with VATS, RATS was associated with significant reduction in intraoperative blood loss, time to chest tube removal and postoperative hospital stay. The operative time, conversion rate, lymph nodes removed, morbidity and mortality were similar between the two groups.ConclusionRobotic-assisted lung resection is safe and effective with low conversion rate and less complications, and it can overcome many disadvantages of traditional VATS.
Objective To investigate the utilization of platinum drugs in 21 hospitals of Chengdu from 2011 to 2014. Methods The utilization information of platinum drugs in 21 hospitals of Chengdu from 2011 to 2014 was extracted, and the dosage form of drugs, consumption sum, frequency of drug use (DDDs), defined daily cost (DDC), and drug sequence ratio (B/A) were analyzed statistically. Results From 2011 to 2014, the total consumption sums and DDDs of platinum drugs were increased year by year. The consumption sums of oxaliplatin were the highest, and the consumption sums of carboplatin were increased year by year. Oxaliplatin, nedaplatin, and lobaplatin were ranked first, second and fifth respectively in all the four consecutive years; the total DDDs of patinum drugs from 2011 to 2014 showed a trend of increase, DDDs of cisplatin were always ranked first, followed by oxaliplatin; DDC and sorting of platinum drugs were relatively stable, and B/A values of carboplatin and cisplatin were close to 1.00. Conclusion The utilization of platinum drugs in 21 hospitals of Chengdu is in accordance with the principle of safety, effectiveness, economy and convenience.
Abstract Objective To investigate the disease constitution and hospitalization expenses in Songqiao Central Township Health Center (SqC) in Gaoyou City of Jiangsu Province in 2010, so as to provide the baseline data of disease burden for further study. Methods The inpatient records of SqC in 2010 were collected. The first discharge diagnoses were classified according to the International Classification of Disease 10 (ICD-10). The general information of the inpatients, discharge diagnosis, hospitalization expenses, disease category, age, gender, and reimbursement of expenses were described and analyzed by using Microsoft Excel 2003 and SPSS 13.0 software. Results a) The total number of inpatients was 1036 in 2010, and the gender ratio was about 1.0 (50.7% vs. 49.3%); b) The disease spectrum included 17 categories. The cumulative percents of the top 5 systematic diseases were 81.2%, including the respiratory, digestive, neoplasm, circulatory diseases, and injury, poisoning amp; external causes; c) The top 15 diseases were pneumonia, fracture, malignant neoplasm, benign neoplasm, acute bronchitis, cerebral infarction, hypertension, acute appendicitis, emphysema, cholecystolithias accompanied with cholecystitis, inguinal hernia, coronary heart disease, diabetes mellitus, chronic bronchitis and superficial injury; d) The patients suffering from pneumonia and acute bronchitis were mainly over 65 years old and younger than 5; e) The number of chronic diseases significantly increased with age, especially after the age of 35 years old, and reached the peak at the age over 65 years old; while the acute diseases were mainly distributed at the age younger than 15 yeas old and older than 65 years old. The average length of stay, the total hospitalization and out-of-pocket expenses per capita of the chronic diseases were more than those of the acute ones (13.8 days vs. 9.9 days, ? 3 082 vs. ? 2 615; ? 417 vs. ? 371, respectively); f)The length of stay and total hospitalization per capita were quite higher than the other township health centers (11.6 days vs. 5.2 days, ? 3 001.4 vs. ? 1 004.6); and g) Both of the total reimbursement and out-of-pocket expenses per capita accounted for 44%-57% of the total hospitalization expenses. Among the total reimbursement, the payment from New Cooperative Medical Scheme (NCMS) accounted for over 99%, while that from Medical Aid Scheme only accounted for less than 2%. Conclusion a) The top 3 systematic diseases of SqC are seen in respiratory system, digestive system and neoplasm. The acute diseases are mainly pneumonia and fracture; b) The number of acute or chronic diseases increases significantly with age, especially after 35 years old. Both adolescents and the aged suffer from the heaviest burden of diseases; c) The average length of stay and hospitalization expenses pre capita of SqC are much higher than those of the other township health centers; and d) NCMS is the major source of reimbursement. However, the proportion of out-of-pocket expenses and the burden of diseases are still very high and heavy. Thus the policy of NCMS needs to be adjusted step by step in future.
It's common that general rules exist in a certain classification. The general rules of expense classification enable us to judge the category of a patient as soon as possible and to curb the expense. Theory of rough set helps us reach the best reduction of attributes. Based on the core attributes, classification rules are put forward by value reduction. The results show that 10 core attributes remain in 21 attributes of 1527 inpatients' information and 76 classification rules are founded. All of 76 rules guide classification of the patients. 44 of the 76 rules define the only category of a patient, the other 32 rules defines the potential catagories of a patient. Meanwhile, equal attributes of the same category are summerized to guide the cost control of patients. The results indicate that the theory of rough set is effective in attributes reduction and rule generalization of patient expense classification, and it has important significance on medical practice.
ObjectivesTo analyze the average daily medical expenditures for primary liver cancer in China from 2002 to 2011.MethodsThis study employed retrospective survey on multiple centers from 12 provinces and cities in China from 2002 to 2011, based on the continuous data from the Cancer Screening Program in the Urban China Project. The average daily medical expenditures of primary liver cancer patients and influencing factors were analyzed.ResultsA total of 11 045 liver cancer patients from 12 provinces and cities were included, with an average age of 55 and an average duration of hospitalization of 16.76 days. The average daily medical expenditures of liver cancer patients during the 10 years was 1 251 yuan (95%CI 1 236 to 1 266). The average daily medical expenditures was significantly different in regions (1 356 yuan in the east region, 1 209 yuan in the middle region and 1 068 yuan in the west region), types of hospital (1 341 yuan in general hospitals, 1 213 yuan in specialized hospitals) and hospital levels (1 293 yuan in 3A grade hospital, 805 yuan in non-3A grade hospital) (P<0.05). The average daily medical expenditures were 1 253 yuan for stage Ⅰ, 1 169 yuan for stage Ⅱ, 1 167 yuan for stageⅢ and 1 092 yuan for stage Ⅳ (P<0.05). From 2002 to 2011, the average daily medical expenditures of hospitalization increased from 1 079 yuan (95%CI 1 021 to 1 136) to 1 549 yuan (95%CI 1 486 to 1 613), with an average growth rate of 3.69%. Since 2007, a continuous growth was observed. Subgroup analysis suggested there were obvious differences in growth patterns between different regions and hospitals, as well as differences between various treatments.ConclusionsThe average daily medical expenditures of liver cancer in China had been increasing from 2002 to 2011 and there were significant differences between various regions and hospital levels. Combined with data on the change of duration of hospitalization, it can provide reference for the economic evaluation of the nation’s prevention and treatment policies for liver cancer.
Object To investigate the constitution and expense of inpatient diseases in Jili Community Health Service Center (JCHSC) in Liuyang City of Hunan Province from 2008 to 2010, so as to provide baseline data for further study. Methods The questionnaire was applied and inpatient records in JCHSC between 2008 and 2010 were collected. The diseases were classified and standardized according to the International Classification of Disease, 10th Edition (ICD-10) based on the first diagnosis extracted from discharge records. Such information as general condition, discharge diagnosis and medical expenses etc. were analyzed by using statistic software of Microsoft Excel 2003 and SPSS 13.0. Results a) There were 9 chronic diseases and 6 acute ones among the top 15 single diseases, and both the average hospital stay and per-average hospitalization expense of chronic diseases were higher than those of acute ones (7.8 days vs. 5.6 days; ?2 733 vs. ?1551); b) Per-average expense of drugs as for both acute and chronic diseases accounted for nearly 50% of the total/general expense; c) There were 3 types of treatment models in JCHSC. Model A was only the internal medicine therapy, Model B was internal medicine assisted with surgery, and Model C was surgery assisted with internal medicine therapy; d) In detail, the total per-average expenses in JCHSC between 2008 to 2010 as for each single disease were as follows: coronary heart diseases (CHD, ?2 374 to ?2 680), urinary calculi (?3 268 to ?3 337), chronic bronchitis (?2 452 to ?2 488); e) Per-average hospitalization expenses in internal departments were ?1 719 to ?1 942 for acute diseases and ?2 386 and ?2 523 for chronic ones. Among surgical departments, the per-average hospitalization expenses as for acute diseases and chronic diseases were ?1 438 to ?1 579 and ?3 044 to ?3 607, respectively; and f) The average hospital stay for acute diseases in internal departments were 5.5 to 5.8 days for acute diseases and 6.9 to 7.3 days for chronic ones. By contrast, those in surgical departments were 5.9 to 6.2 days for acute diseases and 8.3 days for chronic ones, respectively. Conclusion a) In JCHSC, a total of 7 inpatient diseases among the top 15 single diseases in 2010 are all chronic with per-average total expense over ?2 000, which is higher than the average level of national CHSC (?2 357.6); b) According to the features of expense constitution models of the inpatient single diseases, the hospitalization expense should be controlled specifically; c) There are 3 kinds of diseases with yearly-increasing per-average total expenses as CHD, hypertension and pulmonary infection during recent 3 years; meanwhile, 4 diseases are with yearly-decreasing per-average total expenses as chronic bronchitis, cholecystolithias or accompanied with cholecystitis, diabetes and inguinal hernia; d) The per-average expenses of chronic diseases in surgical departments are higher than those in internal departments, but those of the acute diseases in surgical departments are lower. Meanwhile, the per-average total expenses as for both chronic and acute diseases in surgical departments present a decline trend year by year. Although the per-average expense on drugs as for both acute and chronic diseases in internal departments show a decline trend, the per-average total expenses indicate an ascending trend; and f) The average hospital stay of chronic diseases is longer than acute ones, while that of the surgical diseases is also longer than internal ones.