Institute for Hospital Management, Tsinghua Shenzhen International Graduate School, Tsinghua University, Shenzhen, China.
School of Economics and Management, University of Science and Technology Beijing, Beijing, China.
Front Public Health. 2022 Jun 28;10:880951. doi: 10.3389/fpubh.2022.880951. eCollection 2022.
This study aimed to introduce bed-day payment for rehabilitation services in City S, China, and analyze the cost of inpatient rehabilitation services. Key issues were defined and relevant countermeasures were discussed.
The data about the rehabilitation cost of 3,828 inpatient patients from June 2018 to December 2019 was used. Descriptive statistics and the Kruskal-Wallis test were employed to describe sample characteristics and clarify the comparity of cost and length of stay (LOS) across different groups. After normalizing the distribution of cost and LOS by Box-Cox transformation, multiple linear regression was used to explore the factors influencing cost and LOS by calculating the variance inflation factor (VIF) to identify multicollinearity. Finally, 20 senior and middle management personnel of the hospitals were interviewed through a semi-structured interview method to further figure out the existing problems and countermeasures.
(1) During 2015-2019: both discharges and the cost of rehabilitation hospitalization in City S rose rapidly. (2) The highest number of discharges were for circulatory system diseases (57.65%). Endocrine, nutritional, and metabolic diseases were noted to have the longest average length of stay (ALOS) reaching 105.8 days. The shortest ALOS was found to be 24.2 days from the diseases of the musculoskeletal system and connective tissue. Neurological, circulatory, urological, psychiatric, infectious, and parasitic diseases were observed to be generally more costly. (3) The cost of rehabilitation was determined to mainly consist of the rehabilitation fee (23.63%), comprehensive medical service fee (22.61%), and treatment fee (19.03%). (4) Type of disease, age, nature of the hospital, and grade of the hospital have significant influences both on cost and LOS ( < 0.05). The most critical factor affecting the cost was found to be the length of stay (standardized coefficient = 0.777). (5) The key issues of City S's rehabilitative services system were identified to be the incomplete criteria, imperfections in the payment system, and the fragmentation of services.
Bed-day payment is the main payment method for rehabilitation services, but there is a conflict between rapidly rising costs and increasing demand for rehabilitation. The main factors affecting the cost include the length of stay, type of disease, the grade of the hospital, etc. Lack of criteria, imperfections in the payment system, and the fragmentation of services limit sustainability. The core approach is to establish a three-tier rehabilitative network and innovate the current payment system.
本研究旨在引入中国 S 市的康复服务床位日付费，并分析住院康复服务的成本。定义了关键问题并讨论了相关对策。
使用了 2018 年 6 月至 2019 年 12 月期间 3828 名住院患者的康复成本数据。采用描述性统计和 Kruskal-Wallis 检验描述样本特征，并阐明不同组之间的成本和住院时间（LOS）的可比性。通过 Box-Cox 变换对成本和 LOS 的分布进行归一化后，采用多元线性回归通过计算方差膨胀因子（VIF）来探索影响成本和 LOS 的因素，以确定是否存在多重共线性。最后，通过半结构式访谈方法对医院的 20 名中高级管理人员进行访谈，进一步了解存在的问题和对策。
（1）2015-2019 年：S 市的出院人数和康复住院费用均呈快速增长趋势。（2）出院人数最多的是循环系统疾病（57.65%）。内分泌、营养和代谢疾病的平均住院时间最长，达到 105.8 天。肌肉骨骼系统和结缔组织疾病的最短住院时间为 24.2 天。神经系统、循环系统、泌尿系统、精神科、传染病和寄生虫病的费用普遍较高。（3）康复费用主要由康复费（23.63%）、综合医疗服务费（22.61%）和治疗费（19.03%）构成。（4）疾病类型、年龄、医院性质和医院级别对成本和 LOS 均有显著影响（<0.05）。对成本影响最大的因素是住院时间（标准化系数=0.777）。（5）确定了 S 市康复服务体系的关键问题是标准不完整、支付制度不完善和服务碎片化。
床位日付费是康复服务的主要支付方式，但成本快速上升与康复需求增加之间存在冲突。影响成本的主要因素包括住院时间、疾病类型、医院级别等。标准缺失、支付制度不完善和服务碎片化限制了可持续性。核心方法是建立三级康复网络并创新现行支付制度。
