Zhou Li-Fang, Zhang Mao-Xin, Kong Ling-Qian, Liu Jun-Jun, Feng Qi-Ming, Lu Wei, Wei Bo, Zhao Lue Ping
Guangxi Medical University, Nanning, Guangxi, China.
Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, Guangxi, China.
PLoS One. 2017 Mar 16;12(3):e0173451. doi: 10.1371/journal.pone.0173451. eCollection 2017.
The rising cost of healthcare is of great concern in China, as evidenced by the media features negative reports almost daily. However there are only a few studies from well-developed cities, like Beijing or Shanghai, and little is known about healthcare costs in rest of the country. In this study, we use hospitalization summary reports (HSRs) from admitted cardiovascular diseases patients in Guangxi hospitals during 2013-2016, and we investigate temporal trends of healthcare costs and associated factors.
By generalized additive model, we compute temporal trends of cost per stay (CPS), cost per day (CPD) and others. We then use generalized linear models to assess which factors associate with CPS and CPD.
Using a total of 760,000 HSRs, we find that CPS appears to be stabilized around $1040 until the middle of year 2015, before exhibiting a downward trend. Similarly, CPD exhibits similar stable pattern. Meanwhile, surgery-specific CPS showed an increase in year 2013-2014, and then stabilized. Drug costs account for over 1/3 of CPS, but they are gradually declining. Costs associated with physicians' and nurses' services represent less than 5% of CPS. We found that age, sex, marital status, occupation and payment methods are significantly associated with CPS or CPD. Interestingly, we found no association between patient ethnicity and these costs. However, we did find that minority patients use more secondary hospitals than Han patients.
Healthcare costs in Guangxi are stable, contrary to the rise portrayed by Chinese mass media. Several factors can be associated with healthcare costs, and these may be useful for developing evidence-based policies. In particular, there is a need to encourage more Han patients to seek care in primary and secondary hospitals.
医疗保健成本的不断上升在中国备受关注，媒体几乎每天都有负面报道。然而，只有少数来自北京或上海等发达城市的研究，对于中国其他地区的医疗保健成本知之甚少。在本研究中，我们使用了2013 - 2016年广西医院收治的心血管疾病患者的住院总结报告（HSR），并调查了医疗保健成本的时间趋势及相关因素。
通过广义相加模型，我们计算每次住院费用（CPS）、每日费用（CPD）等的时间趋势。然后使用广义线性模型评估哪些因素与CPS和CPD相关。
使用总共760,000份HSR，我们发现直到2015年年中，CPS似乎稳定在1040美元左右，之后呈下降趋势。同样，CPD也呈现出类似的稳定模式。同时，特定手术的CPS在2013 - 2014年有所增加，然后稳定下来。药品成本占CPS的三分之一以上，但它们在逐渐下降。与医生和护士服务相关的成本占CPS的比例不到5%。我们发现年龄、性别、婚姻状况、职业和支付方式与CPS或CPD显著相关。有趣的是，我们发现患者的民族与这些成本之间没有关联。然而，我们确实发现少数民族患者比汉族患者更多地使用二级医院。
广西的医疗保健成本是稳定的，这与中国大众媒体所描绘的上升情况相反。几个因素可能与医疗保健成本相关，这些因素可能有助于制定基于证据的政策。特别是，有必要鼓励更多汉族患者到基层和二级医院就医。
