Tuvdendorj Ariuntuya, Dechinkhorloo Otgonjargal, Dorjsuren Bayarsaikhan, Buskens Erik, Feenstra Talitha
Department of Health Policy, School of Public Health, Mongolian National University of Medical Sciences, Zorig street, Ulaanbaatar, 14210, Mongolia.
Department of Epidemiology, Groningen University, University Medical Center Groningen, Groningen, the Netherlands.
BMC Health Serv Res. 2021 Nov 27;21(1):1280. doi: 10.1186/s12913-021-07281-8.
Non-communicable diseases (NCDs) consistently pose a huge economic burden to health systems and countries in general. The aim of this study was to quantify inpatient costs associated with chronic obstructive pulmonary disease, stroke and ischemic heart disease stratified by type of referral pathway, and to investigate key factors that drive these costs.
A registry-based data analysis was performed using national public hospital inpatient records from 2016 to 2018 for 117,600 unique patients and linking patient-level inpatient health care use with hospital-specific unit cost per bed-day. These were combined to calculate the annual inpatient costs for each of the three disorders per person and per year. Generalized linear modeling was used to assess the association of inpatient costs with age, gender, location, comorbidity, treatment referral pathways and years.
Across three diagnoses, the majority of patients were female. Most were over 50-60 years old, with more than half being a pensioner, typically with at least one comorbidity. About 25% of patients followed what might be considered inappropriate (unofficial) inpatient referral pathways. Mean annual inpatient costs were int$ 721. These costs rose to int$ 849 for unofficial pathways and dropped to int$677 for official pathways. Further covariates significantly associated with high inpatient costs were location, age, gender, and comorbidity.
Our findings provide background information essential to develop evidence-based and cost-effective interventions aimed at health promotion, prevention and service delivery. Reducing the unofficial use of inpatient care can improve efficient resource allocation in health care and prevent further escalation of inpatient costs in the future.
非传染性疾病总体上持续给卫生系统和各国带来巨大经济负担。本研究的目的是按转诊途径类型对慢性阻塞性肺疾病、中风和缺血性心脏病的住院费用进行量化，并调查驱动这些费用的关键因素。
使用2016年至2018年全国公立医院117600名独特患者的住院记录进行基于登记处的数据分析，并将患者层面的住院医疗使用情况与医院特定的每日床位成本联系起来。将这些数据结合起来计算三种疾病中每种疾病每人每年的年度住院费用。使用广义线性模型评估住院费用与年龄、性别、地点、合并症、治疗转诊途径和年份之间的关联。
在三种诊断中，大多数患者为女性。大多数患者年龄在50至60岁以上，超过一半是领取养老金者，通常至少有一种合并症。约25%的患者遵循可能被认为不合适（非官方）的住院转诊途径。平均年度住院费用为721国际元。非官方途径的这些费用升至849国际元，官方途径则降至677国际元。与高住院费用显著相关的其他协变量是地点、年龄、性别和合并症。
我们的研究结果为制定旨在促进健康、预防和提供服务的循证且具有成本效益的干预措施提供了重要的背景信息。减少住院治疗的非官方使用可以提高医疗保健资源的有效分配，并防止未来住院费用进一步攀升。
