Analysis of hospitalization expenses and influencing factors in surgery for patients with cystic echinococcosis in Ningxia during 2016—2021

doi:10.12140/j.issn.1000-7423.2023.01.011

Abstract

Abstract:

Objective To investigate the hospitalization expenses of patients with cystic echinococcosis undergoing surgery in Ningxia for providing reference basis to reduce the economic burden hospitalized patients. Methods Data from patients who underwent cystic echinococcosis surgery from 2016 to 2021 in Ningxia were collected, including the patient’s basic information, the number of hospitalisation days and the cost of surgery and other information. SPSS 20.0 statistical software was used for statistical analysis. The average hospitalization cost was expressed in median per capita. Z test and F test were used for comparison among groups. The hospitalization expense was assigned as dependent variable. The surgery year, gender, age, occupation, education level, number of operations, hospital grade, the time interval from diagnosis to operation and the days staying in hospital were taken as independent variables for multiple linear logistic regression analysis. Result A total of 486 patients’ information undergoing surgery were collected, of them the total hospital cost, average cost per patient and the median cost was 11.391 million yuan, 23 438.7 yuan, and 20 362.5 yuan. Hospitalization expense mainly include 17 categories, the top 3 median expenses were drug fee (8 030.0 yuan), consumble material fee (5 000.0 yuan) and operation fee (3 436.4 yuan). The median hospitalization expenses of men and women were 20 126.1 yuan and 20 931.4 yuan, respectively, with no significant difference (Z = -0.552, P > 0.05). The median hospitalization expenses of patients aged 40-59 years was the highest, which was 20 835.5 yuan. The difference of hospitalization expenses among different age groups was statistically significant (Z = 8.2, P < 0.05). Among different occupational patients, the median hospitalization expense of other occupational patients was the highest, which was 22 655.0 yuan. There was no statistically significant difference in hospitalization expense of different occupational patients (Z = 1.838, P > 0.05). The median hospitalization expenses of illiterate patients was the highest, which was 23 286.4 yuan. There was no statistically significant difference in hospitalization expenses of patients with different education levels (Z = 6.729, P > 0.05). The hospitalisation cost of patients with a time interval of more than 1 year from diagnosis to surgery (20 830.1 yuan) was higher than that of patients with an interval of ≤ 1 year (19 127.0 yuan) (Z = -2.121, P < 0.05). From 2016 to 2021, the hospitalization expense of patients with one operation (20 274.3 yuan) is lower than that of patients with multiple operations (20 963.0 yuan) (Z = -2.079, P < 0.05). The median hospitalization expense of patients with hospitalization time ≤ 21 days (19 768.9 yuan) was lower than that of patients with hospitalization time > 21 days (30 732.0 yuan) (Z = 9 069.5, P < 0.01). There was no statistically significant difference between the median hospitalization expenses of patients with medical insurance (20 313.0 yuan) and those without medical insurance (29 798.5 yuan) (Z = -1.392, P > 0.05). The median hospitalization cost of patients undergoing hepatectomy was the highest (31 640.5 yuan), and the median hospitalization cost of patients undergoing different surgical methods was statistically significant (Z = 22.174, P < 0.01). From 2016 to 2021, the median hospitalization expense increased from 17 689.5 yuan to 27 090.0 yuan (Z = 27.560, P < 0.01). The median hospitalization expenses of provincial, municipal and county hospitals were 26 227.0 yuan, 16 979.0 yuan and 12 988.1 yuan, respectively. The median hospitalization expenses decreased with the decline of hospital level (Z = 146.875, P < 0.01). The average days staying in provincial and municipal hospitals is 14 days, and that in county-level hospitals is 15 days. There was a statistically significant difference in the number of days staying in hospitals of different levels (F = 9.594, P < 0.05). Multivariate logistic regression analysis showed that four factors, including operation mode, hospital level, days staying in hospital and operation year, were related to hospitalization expenses (P < 0.05). Among 486 patients, the total subsidy of the national echinococcosis project, the average cost per person and the median cost per person were 2 732 224.6 yuan, 5 621.9 yuan and 6 000.0 yuan. The total, the average capita and median of out-of-pocket expenses for each patient were 1 864 120.1 yuan, 8 176.0 yuan and 6 169.0 yuan respectively. After medical insurance and national hydatid disease project subsidies, the majority had no out-of-pocket payment accounting for 53.1% (258/486), followed by 15.2% (74/486) paid 1 000-4 999 yuan out-of-pocket and 15.2% (74/486) paid 5 000-9 999 yuan out-of-pocket. The percentage of patients with no out-of-pocket fee increased from 41.7% (45/108) in 2016 to 63.6% (35/55) in 2020 and decreased to 35.9% (23/64) in 2021. Conclusion From 2016 to 2021, the median hospitalization expenses of patients for surgery on cystic echinococcosis in Ningxia increased year by year, while the proportion of patients with no out-of-pocket fees increased year by year, but decreased to 35.9% in 2021. It is suggested that the subsidy standard of the hydatid disease prevention and control project should be appropriately raised, and patients are encouraged to choose a nearby designated hospital for treatment, so as to reduce the hospitalization costs.

Key words: Echinococcosis, Hospitalization expenses, Influencing factors

CLC Number:

R532.3

DUAN Hongju, LI Lingjie, WU Xianglin, YAN Fang, QI Rongting, MA Tianbo. Analysis of hospitalization expenses and influencing factors in surgery for patients with cystic echinococcosis in Ningxia during 2016—2021[J]. CHINESE JOURNAL OF PARASITOLOGY AND PARASITIC DISEASES, 2023, 41(1): 75-80.

Figures/Tables 5

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References 16

[1]	Xu HR, Liu XX, Zhang JS. Surveillance data of brucellosis in Shanghe couty, 2009—2014[J]. Mod Prev Med, 2016, 43(19): 3611-3614. (in Chinese)
	(许华茹, 刘晓雪, 张吉山. 2009—2014年商河县人间布鲁氏菌病监测资料分析[J]. 现代预防医学, 2016, 43(19): 3611-3614.)
[2]	Duan HJ, Wu XL, Qi RT, et al. Analysis of surveillance results of echinococcosis in Ningxia in 2017[J]. Chin J Parasitol Parasit Dis, 2019, 37(4): 433-436. (in Chinese)
	(段红菊, 吴向林, 齐蓉婷, 等. 2017年宁夏棘球蚴病监测结果分析[J]. 中国寄生虫学与寄生虫病杂志, 2019, 37(4): 433-436.)
[3]	Ma M, Chen T, Yang YY. Study on DRGs grouping patients with patients with echinococcosis based on decision tree model[J]. Chin Med Rec, 2022, 23(8): 33-37. (in Chinese)
	(马明, 陈婷, 杨圆圆. 利用决策树模型的包虫病患者住院费用及病例组合分析[J]. 中国病案, 2022, 23(8): 33-37.)
[4]	Yu HM, Shi R, Yang Y, et al. Direct medical expenses of hospitalization for serious echinococcosis in Ganzi Tibetan Autonomous Prefecture[J]. Chin Health Resour, 2020, 23(5): 457-460. (in Chinese)
	(余红梅, 石锐, 杨义, 等. 甘孜藏族自治州包虫病大病住院的直接医疗费用[J]. 中国卫生资源, 2020, 23(5): 457-460.)
[5]	Zhang MY, Wu WP, Guan YY, et al. A survey on medical expenditure of hepatic echinococcosis surgery in a Tibetan Region and the related influencing factors[J]. Chin J Parasitol Parasit Dis, 2017, 35(3): 250-253. (in Chinese)
	(张梦媛, 伍卫平, 官亚宜, 等. 藏区肝棘球蚴病患者手术医疗费用及其相关影响因素分析[J]. 中国寄生虫学与寄生虫病杂志, 2017, 35(3): 250-253.)
[6]	Liu P, Cai L, Li AM, et al. Analysis of influencing factors on length of stay and total cost in surgery patients of gastric cancer[J]. Chin Med Rec, 2021, 22(10): 50-53. (in Chinese)
	(刘萍, 蔡林, 李爱民, 等. 胃癌手术患者住院天数及住院总费用影响因素分析[J]. 中国病案, 2021, 22(10): 50-53.)
[7]	Tang Y, Li L, Yin LY, et al. Influence factors analysis of hospitalization expenses in orthopedic surgery patients[J]. Guangzhou Med J, 2020, 51(2): 117-122. (in Chinese)
	(唐瑶, 李凌, 尹龙燕, 等. 骨科手术患者住院费用影响因素分析[J]. 广州医药, 2020, 51(2): 117-122.)
[8]	Wu MP, Liu P, Xu W, et al. Analysis on the structure and influencing factors of a hospital[J]. Chin Med Rec, 2021, 22(9): 76-80. (in Chinese)
	(吴梦平, 刘萍, 徐渭, 等. 某院手术患者住院费用构成与影响因素分析[J]. 中国病案, 2021, 22(9): 76-80.)
[9]	Yan LY. Research progress of hepatectomy in the treatment of hepatic echinococcosis[J]. World Latest Med Inf, 2016, 16(A3): 43-44. (in Chinese)
	(严利燕. 肝叶切除术治疗肝包虫病的研究进展[J]. 世界最新医学信息文摘, 2016, 16(A3): 43-44.)
[10]	Gao YS, Zhu MB, Guo YZ, et al. Clinical analysis on hepatic hydatid disease in Yili River valley[J]. Chin J Parasitol Parasit Dis, 2005, 23(1): 10-13. (in Chinese)
	(高永盛, 朱马拜, 郭永忠, 等. 新疆伊犁河谷肝棘球蚴病临床资料分析[J]. 中国寄生虫学与寄生虫病杂志, 2005, 23(1): 10-13.)
[11]	Liao Y, Zhu MB. Study on standardized treatment of hepatic echinococcosis[J]. Chin Community Dr, 2011, 13(25): 70-71. (in Chinese)
	(燎原, 朱马拜. 肝包虫病的规范化治疗研究[J]. 中国社区医师(医学专业), 2011, 13(25): 70-71.)
[12]	Dong JH, Huang ZQ. Precise liver resection: new concept of liver surgery in 21st century[J]. Chin J Surg, 2009, 47(21): 1601-1605. (in Chinese)
	(董家鸿, 黄志强. 精准肝切除: 21世纪肝脏外科新理念[J]. 中华外科杂志, 2009, 47(21): 1601-1605.)
[13]	Wang L, Alimu AL, Yao H. Analysis of influencing factors of the direct medical costs of 1958 patients with hydatid disease[J]. Chin Prev Med, 2017, 18(8): 601-604. (in Chinese)
	(王乐, 阿力木·艾力, 姚华. 1958例包虫病患者直接医疗费用影响因素分析[J]. 中国预防医学杂志, 2017, 18(8): 601-604.)
[14]	Shao J, Wang ZX, Yang DCR, et al. Analysis of influencing factors on hospitalization expenditures of patients with alveolar echinococcosis in Qinghai-Tibet Plateau[J]. Chin J Dis Control Prev, 2018, 22(2): 168-172. (in Chinese)
	(邵军, 王志鑫, 阳丹才让, 等. 青藏高原地区泡型包虫病患者住院费用影响因素分析[J]. 中华疾病控制杂志, 2018, 22(2): 168-172.)
[15]	Qi XH, Li BL, Yin XF, et al. Analysis of influencing factors for hospitalization and related expenses for hydatid patients receiving surgical treatment in Xinjiang[J]. Chin J Parasitol Parasit Dis, 2018, 36(2): 196-198. (in Chinese)
	(齐新红, 李波霖, 殷雪峰, 等. 新疆棘球蚴病外科救助患者住院及相关费用影响因素分析[J]. 中国寄生虫学与寄生虫病杂志, 2018, 36(2): 196-198.)
[16]	Duan S, Tuerganaili AJ, Jiang TM, et al. Evaluation of clinical pathway in the therapeutic treatment hepatic alveolar echinococcosis[J]. Chin J Oper Proced Gen Surg Electron Ed, 2019, 13(6): 567-570. (in Chinese)
	(段帅, 吐尔干艾力·阿吉, 蒋铁民, 等. 肝泡型包虫病临床路径实施效果评价[J]. 中华普外科手术学杂志(电子版), 2019, 13(6): 567-570.)

费用类别 Expense category	中位数/元 Median/Yuan	顺位 Ordinal no.
药品费 Drug fee	8 030.0	1
材料费 Consumptive material fee	5 000.0	2
手术费 Operating fee	3 436.4	3
化验费 Laboratory fee	1 896.7	4
治疗费 Treatment fee	1 745.9	5
检查费 Examination fee	1 142.7	6
放射费 Radiation fee	439.2	7
床位费 Bed fee	410.4	8
护理费 Nursing fee	407.0	9
输血费 Blood transfusion fee	292.7	10
输氧费 Oxygen fee	167.9	11
中成药费 Chinese medicines fee	142.8	12
其他 Others	117.6	13
病检费 Fee for medical examination	84.5	14
诊疗费 Medical fee	66.9	15
取暖费 Heating fee	30.2	16
监护费 Tutelage fee	24.6	17
合计 Total fee	20 362.5

特征 Characteristics	患者数 No. patient	构成比/% Constituent/%	住院费用中位数/元 Median of hospitalization cost/Yuan
性别 Gender
男 Male	244	50.2	20 126.1
女 Female	242	49.8	2 0931.4
年龄组/岁 Age group/Year
0~19	9	1.9	16 421.0
20~39	93	19.1	19 105.0
40~59	264	54.3	20 835.5
≥ 60	120	24.7	20 794.0
职业 Occupation
农民 Farmer	472	97.1	20 335.5
儿童及学生 Children and students	5	1.0	14 282.0
其他 Others	9	1.9	22 655.0
文化程度 Degree of education
文盲 Illiteracy	98	20.2	23 286.4
小学 Primary school	193	39.7	20 313.0
初中及中专 Middle school	169	34.8	19 587.0
高中及高职 High school	18	3.7	22 496.5
大专及以上 College and above	8	1.6	23 877.7
确诊至手术的时间间隔 Time interval from diagnosis to operation
≤ 1年 ≤ 1 Year	181	37.2	19 127.0
> 1年 > 1 Year	305	62.8	20 830.1
手术次数 Operation number
1	369	75.9	20 274.3
> 1	117	24.1	20 963.0
住院天数 Days staying in hospital
≤ 21 d	417	85.8	19 768.9
> 21 d	69	14.2	30 732.0
医保 Medical insurance
无No	6	1.2	29 798.5
有Yes	480	98.8	20 313.0
手术方式 Operation procedure
外囊剥除术 Extraystic dissection	377	77.6	19 472.5
内囊摘除术 Internal and external cystectomy	70	14.4	20 293.7
肝切除术 Liver resection	39	8.0	31 640.5
手术年份 Operation year
2016	108	22.2	17 689.5
2017	85	17.5	18 458.0
2018	87	17.9	19 231.0
2019	87	17.9	20 841.0
2020	55	11.3	23 497.0
2021	64	13.2	27 090.0
合计 Total	486	100	20 362.5

医院级别Hospital level	患者数 No. patient	构成比/% Constituent/%	住院费用 Hospitalization expenses			住院天数 No. of hospitalization day
医院级别Hospital level	患者数 No. patient	构成比/% Constituent/%	中位数 Median	最大值 Maximum	最小值 Minimum	中位数 Median	最大值 Maximum	最小值 Minimum
省 Provincial	241	49.6	26 227.0	91 715.0	7 298.0	14	44	3
市级 City	129	26.5	16 979.0	74 944.0	3 887.4	14	53	2
县级 County	116	23.9	12 988.1	35 034.0	5 637.0	15	35	3
合计 Total	486	100	20 362.5	91 715.0	3 887.4	14	53	2

变量 Variable	赋值 Assignment	回归系数 Regression coefficient	标准误 SE	标准化回归系数 Standardized confficients	t	P
常量 Constant		13 022.983	4 810.498		2.707	< 0.05
性别 Gender	0 = 男Male，1 = 女Female	-840.022	920.486	-0.032	-0.913	> 0.05
年龄 Age	用原始数据 Using the raw data	64.107	38.099	0.065	1.683	> 0.05
职业 Occupation	0 = 农民Farmer，1 = 儿童和学生Children and students，2 = 其他Other	-2 014.990	1 601.218	-0.044	-1.258	> 0.05
文化程度 Degree of education	0 = 文盲Illiteracy，1 = 小学Primary school，2 = 初中/中专Junior high school/technical secondary school，3 = 高中/高职High school/vocational high school，4 = 大专及以上College or above	522.991	571.201	0.035	0.916	> 0.05
确诊至手术的时间间隔Time interval from diagnosis to operation	用原始数据 Using the raw data	0.311	50.394	0.000	0.006	> 0.05
手术次数 No. operation	0 = 1次 Once，1 = 2次及以上 2 or more times	974.002	1 210.774	0.031	0.804	> 0.05
手术方式 Operation procedure	0 = 外囊完整剥除术Extraystic dissection，1 = 内囊摘除术Internal and external cystectomy，2 = 肝切除术Liver resection	1 719.579	803.367	0.075	2.140	< 0.05
医院级别 Hospital level	0 = 省级医院Provincial，1 = 市级City，2 = 地市级医院，3 = 县级医院County	-7 820.949	556.845	-0.486	-14.045	< 0.05
住院天数 Days staying in hospital	用原始数据 Using the raw data	866.314	68.187	0.440	12.705	< 0.05
医保 Medical insurance	0 = 无No，1 = 有Yes	-4 942.721	4 095.823	-0.041	-1.207	> 0.05
手术年份 Operation year	0 = 2016，1 = 2017，2 = 2018，3 = 2019， 4 = 2020，5 = 2021	1 106.999	276.922	0.142	3.998	< 0.05