Research on the Current Situation and Countermeasures of Inpatient Cost and Medical Insurance Payment Method for Rehabilitation Services in City S.

OBJECTIVE

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.

METHODS

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.

RESULTS

(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.

CONCLUSIONS

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.