ObjectiveTo compare the cost changes of total knee arthroplasty (TKA) before and after the cancellation of medical consumables addition, so as to provide reference for the national medical reform policy.MethodsThe patients treated with TKA between September 2018 and February 2019 were admitted as objects of study, and 372 of them met the selection criteria and were finally included in the study. According to the time node of cancelling the medical consumables addition (December 24, 2018), all patients were allocated to pre-cancelling and post-cancelling groups (n=186). The clinical data of patients (gender, age, length of stay, disease classification), and various treatment costs (the costs of diagnosis and treatment, examination, laboratory, material, anesthesia, bed, nursing, operation, drug, and others) were collected. And the changes of various costs and proportions before and after cancelling the medical consumables addition were compared.ResultsThere was no significant difference in gender, age, and disease classification between the two groups (P>0.05); the length of stay after cancelling the medical consumables addition was significantly longer than that before cancelling (t=2.114, P=0.035). There was no significant difference in the total cost of TKA before and after cancelling the medical consumables addition (t=0.214, P=0.831). Compared with that before cancelling the medical consumables addition, the cost of material was significantly reduced, and the costs of diagnosis and treatment, anesthesia, nursing, and operation were significantly increased (P<0.05); the costs of examination, laboratory , bed, drug, and others were basically stable, and the differences were not significant (P>0.05).ConclusionThe total cost of TKA is stable, the proportion of material cost is significantly reduced, the proportion of diagnosis and treatment cost reflecting the technical content of medical staff is significantly increased, which is in line with the expectation of the national policy of cancelling the medical consumables addition.
Objective To investigate the variation of total hospitalization cost for single-diagnosed disease of different types of acute appendicitis in a three-A hospital, so as to provide evidence for the reimbursement amount of social medical insurance. Methods All patients with acute appendicitis who had surgery treatment during January-April 2011 (before implementing the fee system for single-diagnosed disease) and January-April 2012 (after implementing the fee system for single-diagnosed disease) were collected in this study for analysis. According to the types of acute appendicitis, the patients were stratified into the low risk group (simple, suppurative and gangrenous) and the high risk group (perforative, abscess-formed and pregnancy-combined). The correlation between total hospitalization cost and types of acute appendicitis, as well as the changes of total hospitalization cost after implementing the fee system for single-diagnosed disease were analyzed. Results A total of 90 eligible patients were included. The disease types were positively correlated with hospital stays and total hospitalization cost. All three types in the low risk group could control the average total hospitalization cost within RMB 10 000 yuan. The results of sensitivity analysis showed that, before implementing the fee system for single-diagnosed disease, the total hospitalization cost up to RMB 6 000 yuan could be positively correlated with the above risk stratification (r=0.442, P=0.003). After implementing the fee system for single-diagnosed disease from January to April 2012, the constituent ratio of hospital stays, compared with that in the same period of 2011, had no significant difference (P=0.108) between the two groups; but the ratio of hospital stays (less than 5 days) increased from 45% to 64%, and the ratio of hospital stays (greater than or equal to 10 days) decreased from 17% to 4%, indicating a tendency of shortening hospital stays. Also, the constituent ratio of total hospitalization cost had no significant difference (P=0.114) between the two groups; but the ratio of total hospitalization cost (greater than or equal to RMB 9 000 yuan) decreased from 32% to 13%, indicating a tendency of lowering total hospitalization cost. Conclusion The low risk group of acute appendicitis, RMB 6 000 yuan should be rated as the rational reimbursement amount of social medical insurance. The total hospitalization cost for the high risk group is quite various, so the further studies are needed to investigate the feasibility of the fee system for single-diagnosed disease as well as the rating amount of total hospitalization cost. The implementation of the fee system for single-diagnosed disease is helpful to shorten hospital stays and reduce total hospitalization cost.
Objective To analyze hospitalization cost, length of stay, cost composition, hospital-level differences, and mortality burden of solid tumors related to general surgery in Sichuan Province. MethodsData were obtained from publicly released Sichuan Health Statistical Yearbooks. Six hospitalization-cost diseases closely related to general surgery were included: nodular goiter, acute appendicitis, acute cholecystitis, inguinal hernia, gastric cancer, and esophageal cancer. The solid tumor burden analysis included gastric cancer, esophageal cancer, colorectal cancer, liver cancer, pancreatic cancer, and breast cancer. Hospital admissions, bed occupancy rate, average length of stay, and average inpatient expenditure were used as contextual indicators for surgical inpatient services. Descriptive statistics, proportions, hospital-level cost ratios, and 2019-based indices were performed. Results① General surgery-related disease. In 2023, acute appendicitis (90 353 discharges) and inguinal hernia (61 237 discharges) had the largest discharge volumes among the six hospitalization-cost diseases, with average inpatient costs of 8 243.59 yuan and 9 648.75 yuan, respectively. Gastric cancer and esophageal cancer had longer average length of stay (12.96 days and 12.51 days, respectively) and higher average inpatient costs (30 162.44 yuan and 24 310.18 yuan, respectively). Hospital-level cost differences were most evident for gastric cancer (tertiary/county cost ratio: 3.13) and esophageal cancer (tertiary/county cost ratio: 2.73). The cost composition analysis showed that acute cholecystitis had the highest proportion of diagnosis fees (44.2%), inguinal hernia had the highest proportion of material fees (37.1%), and the proportion of material fees for gastric cancer and esophageal cancer were 29.5% and 27.5%, respectively. ② Solid tumors in general surgery. In 2023, the crude mortality rates of solid tumors related to general surgery, ranked from highest to lowest, were as follows: liver cancer (14.25 per 100 000), colorectal cancer (13.61 per 100 000), esophageal cancer (8.06 per 100 000), gastric cancer (8.00 per 100 000), breast cancer (6.56 per 100 000), and pancreatic cancer (6.46 per 100 000). ③ Hospital inpatient service background. In 2023, hospital admissions in Sichuan Province were 16.364 1 million, increasing by 17.03% compared with 13.982 7 million in 2019. The average length of stay decreased from 10.28 days in 2019 to 9.71 days in 2023, a decrease of 5.54%. The hospital bed occupancy rate was 86.01%, a 3.76% decrease from 89.37% in 2019. The average inpatient cost per discharge increased by 0.88%, from 8 528.00 yuan in 2019 to 8 602.67 yuan in 2023. ConclusionGeneral surgery-related diseases in Sichuan Province are characterized by coexistence of high-volume short-stay diseases, high-cost tumor diseases, and solid tumors with high mortality burden.