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    Home > Active Ingredient News > Drugs Articles > Medical insurance data tells you: does the average cost of medical treatment really decrease when the average cost of medical treatment decreases?

    Medical insurance data tells you: does the average cost of medical treatment really decrease when the average cost of medical treatment decreases?

    • Last Update: 2019-08-19
    • Source: Internet
    • Author: User
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    Reducing the burden of patients' medical treatment is the goal of the medical and health system reform in China Compared with outpatient service, inpatient service has the characteristics of long treatment cycle and high cost of diagnosis and treatment From the perspective of medical service providers, inpatient services occupy a lot of medical resources; from the perspective of medical service demanders, the supply of medical resources is in short supply, and inpatient services bring heavy economic burden to patients and their families It is of great significance to study the changes of hospitalization expenses and its related indicators in recent years for reducing the economic burden brought by disease risk to patients, promoting the rational allocation of medical resources, and standardizing hospital management This paper uses the sample data of inpatients with medical insurance of urban employees in the choras database of China Medical Insurance Research Association from 2013 to 2017 to make descriptive statistics on the change of inpatient expenses of medical insurance of urban employees in 2013 to 2017, and tries to analyze the impact mechanism behind the change of expenses, and clarify the actual reasons for the change of expenses Figure 1 shows the change of the average hospitalization expenses and the income of public hospitals in 2013-2017 In terms of the average hospitalization expenses, the average hospitalization expenses continued to decline from 2013 to 2015, and the average hospitalization expenses changed little from 2015 to 2017 In general, from 2013 to 2017, the average hospitalization expenses of the insured patients decreased steadily, and the average secondary expenses decreased However, with the decrease of the second average cost, we also see that the total income and the number of inpatients are on the rise If the value of inpatient income of public hospitals approximately reflects the total cost level of inpatients, the average inpatient income level of each public hospital continued to rise rapidly from 2013 to 2017, which to some extent reflects the rapid growth trend of the total cost of inpatients in five years The total cost of hospitalization continues to rise, but the average cost of the second hospitalization has decreased The reverse trend of the total cost and the average cost of the second hospitalization is worth pondering Figure 1 the reasons for the increase and decrease of the average hospitalization cost per time and the average total hospitalization income per public hospital in 2013-2017 are as follows: first, the number of inpatients keeps increasing One possible reason is that the rapid growth of the number of inpatients has lowered the average hospitalization cost Figure 2 shows the change of inpatient number and inpatient rate from 2013 to 2017 In terms of the number of inpatients, between 2013 and 2017, the number of inpatients increased continuously, with the growth rates of 6.38%, 3.00%, 8.00% and 7.52% respectively In terms of annual hospitalization rate, the hospitalization rate has been on the rise from 2013 to 2017 The trend of inpatient number and inpatient rate shows that more and more patients receive inpatient treatment in recent years One of the main reasons for the decrease of the second average hospitalization cost is the rapid increase of hospitalization rate The high hospitalization rate means that a large number of patients who do not need to be hospitalized actually have been hospitalized First of all, the policy of reimbursement for medical insurance outpatient service is to improve the hospitalization rate In the current system design, the pooling fund only pays for hospitalization expenses In order to get the reimbursement of the co-ordination fund, patients have the motivation and incentive to be hospitalized Secondly, under the limitation of payment by disease, in order to ensure that the total income does not decrease, there are also incentives and incentives for hospitals to be hospitalized with light diseases and to promote the rate of hospitalization Light patient admission can not only improve the total hospital income, but also reduce the average cost per time, and meet the assessment requirements of the average cost per time based on the payment of diseases Figure 2 the number of inpatients and the annual hospitalization rate in 2013-2017 are the second The number of inpatients is significantly shortened, and the daily average cost of short-term inpatients is significantly reduced Table 1 shows the changes in the distribution of hospitalization days of employee medical insurance patients from 2013 to 2017 Table 1: distribution of inpatient days of employee medical insurance patients in 2013-2017 we define the inpatient days of 0-10 as short-term hospitalization Between 2013 and 2017, the number of short-term inpatients with hospitalization days of 0-5 days and 6-10 days increased significantly The number of patients with hospitalization days of 11-15 days, 16-20 days, 21-25 days, 26-30 days and more than 30 days decreased to varying degrees In general, the length of stay in hospital of employee medical insurance patients is significantly shortened, and the short-term inpatients account for the vast majority of all inpatients See Table 2 for details Table 2 changes in average daily expenses of employees with medical insurance from 2013 to 2017 (unit: yuan) Horizontally, in the five years investigated, the average daily hospitalization expenses decreased with the increase of hospitalization days in each year; vertically, between 2013 and 2017, the average daily expenses of short-term inpatients, especially those with hospitalization days of 0-5 days, decreased significantly To sum up, the length of stay in hospital of employee medical insurance patients is significantly shortened, and the daily average cost of short-term inpatients is significantly reduced, which is also one of the main reasons for the decrease of the second average hospitalization cost of employee medical insurance patients From a positive point of view, the reduction of hospitalization days is the efficiency improvement brought by the payment by disease; however, if considering the rapid increase of hospitalization rate and the possible admission of patients with minor diseases, the reduction of hospitalization days is more likely to be caused by these two reasons Third, the proportion of elderly patients increased significantly Table 3 shows the changes in the distribution of inpatients of employee medical insurance in different age groups from 2013 to 2017 Table 3 age distribution of inpatients of employee medical insurance from 2013 to 2017, the proportion of patients over 60 years old increased rapidly between 2013 and 2017 The data shows that the proportion of patients over 60 years old has reached 58.02%, and this proportion will further increase with the aging process From table 4, it can be seen that between 2013 and 2017, the number of inpatients aged 60-79 years decreased, and the average number of inpatients aged over 80 years increased significantly Table 4 From 2013 to 2017, the increase in the number of elderly patients with different age groups' average hospitalization days (unit: days) may be another reason for the decrease in the average hospitalization expenses of employees' medical insurance patients Due to the limitations of physical conditions, the possibility of large-scale surgery for the elderly patients after admission is reduced, mostly for routine physical examination, drug treatment, or professional care, relatively speaking, the cost of these medical projects is relatively low Conclusion if we only look at the decrease of the average cost of hospitalization, it may mean the improvement of the efficiency of medical services in China However, if we consider the reasons behind the decrease of the sub average cost, the policy meaning of the decrease of the sub average cost needs to be discussed again The statistical analysis of this paper shows that the total cost of hospitalization has not decreased, while the number of inpatients and the rate of hospitalization are increasing The international average hospitalization rate is less than 10%, while the hospitalization rate of employee medical insurance in China reached 17.6% in 2017 Given the disease spectrum, there will be no subversive changes in a short period of time, which means a large number of patients with mild diseases are admitted to hospital The institutional reasons for this phenomenon are complex, but from the perspective of improving the efficiency of the use of medical insurance funds, we should also improve the governance ability of medical insurance funds, especially the regulatory ability of medical insurance, and strengthen the supervision of the use of medical insurance funds in various ways.
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