Gu Yichun, Hao Jiajun, He Da, Sun Hui, Cui Xin, Tian Wenqi, Zhang Yulin, Jin Chunlin, Wang Haiyin
Shanghai Health Development Research Center, Shanghai, China.
School of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
BMC Health Serv Res. 2025 Apr 22;25(1):580. doi: 10.1186/s12913-025-12422-4.
The increasing hospitalization expenses for Gastric Cancer (GC) impose a notable economic burden on society. Although the Chinese government has implemented the Universal Zero Markup Drug Policy (UZMDP) to control the growth of hospitalization expenditures, costs have continued to rise. Identifying the factors influencing the hospitalization expenses of GC patients is crucial. This study aimed to analyze the trends and factors influencing hospitalization expenses of GC patients in Shanghai from 2014 to 2021.
Data were sourced from the Health Network of Shanghai Economic Information Center. We employed interrupted time series analysis (ITSA) to analyze the trends in various medical expenditures before and after the implementation of the UZMDP. The degree of association between various medical expenditures and hospitalization expenditures of GC patients was calculated by using the new grey relational analysis (GRA). Furthermore, multiple linear regression was employed to identify the influencing factors.
A total of 23,335 participants were included in this study. The ITSA results showed an increasing trend in hospitalization expenses following the implementation of UZMDP. Drug expenses decreased immediately post-UZMDP, but subsequently began to rise over time. Post-UZMDP, the expenses of medical consumables, examination, and healthcare services all showed an upward trend. The new GRA indicated that the influencing factors of hospitalization expenses, in order of importance, were expenses for drugs, consumables, healthcare services, and examination. Multivariable linear regression analysis revealed that GC patients aged 60 or below incurred lower hospitalization expenses (Coefficient = -780.06, P = 0.0398). However, factors associated with increased hospitalization expenses included longer length of stay (Coefficient = 1753.01, P < 0.001), surgeries (Coefficient = 29,047.26, P < 0.001), and hospitalization in the tertiary hospitals (Coefficient = 25,485.19, P < 0.001) or secondary hospitals (Coefficient = 17,755.12, P < 0.001).
Hospitalization expenses of GC patients in Shanghai have been rising annually from 2014 to 2021. Despite the implementation of the UZMDP, drug expenses remain a major factor in escalating hospitalization expenses. The hospitalization expenses of GC patients are significantly influenced by several factors, including the demographic characteristics of patients, the severity of diseases, and the levels of hospitals. These findings provide a basis for more effective management of the hospitalization expenses for GC patients.
胃癌（GC）住院费用的不断增加给社会带来了显著的经济负担。尽管中国政府实施了药品零加成政策（UZMDP）以控制住院费用的增长，但费用仍持续上升。确定影响GC患者住院费用的因素至关重要。本研究旨在分析2014年至2021年上海GC患者住院费用的趋势及影响因素。
数据来源于上海经济信息中心健康网络。我们采用中断时间序列分析（ITSA）来分析UZMDP实施前后各项医疗费用的趋势。使用新的灰色关联分析（GRA）计算GC患者各项医疗费用与住院费用之间的关联程度。此外，采用多元线性回归来确定影响因素。
本研究共纳入23335名参与者。ITSA结果显示，UZMDP实施后住院费用呈上升趋势。UZMDP实施后药品费用立即下降，但随后随时间开始上升。UZMDP实施后，医疗耗材、检查和医疗服务费用均呈上升趋势。新的GRA表明，住院费用的影响因素按重要性排序依次为药品、耗材、医疗服务和检查费用。多变量线性回归分析显示，60岁及以下的GC患者住院费用较低（系数 = -780.06，P = 0.0398）。然而，与住院费用增加相关的因素包括住院时间延长（系数 = 1753.01，P < 0.001）、手术（系数 = 29047.26，P < 0.001）以及在三级医院（系数 = 25485.19，P < 0.001）或二级医院住院（系数 = 17755.12，P < 0.001）。
2014年至2021年上海GC患者的住院费用逐年上升。尽管实施了UZMDP，但药品费用仍是住院费用不断攀升的主要因素。GC患者的住院费用受到多种因素的显著影响，包括患者的人口统计学特征、疾病严重程度和医院级别。这些发现为更有效地管理GC患者的住院费用提供了依据。
