Comparison of the Length of Stay and Medical Expenditures among Japanese Hospitals for Type 2 Diabetes Treatments: The Box-Cox Transformation Model under Heteroscedasticity

In this paper, we analyzed length of stay (LOS) in hospitals and medical expenditures for type 2 diabetes patients. LOS was analyzed by the power Box-Cox transformation model when variances differed among hospitals. We proposed a new test and consistent estimator. We rejected the ho-moscedasticity of variances among hospitals, and then analyzed the LOS of 12,666 type 2 diabetes patients hospitalized for regular medical treatments collected from 60 general hospitals in Japan. The variables found to affect LOS were age, number of comorbidities and complications, introduced by another hospital, one-week hospitalization, 2010 revision, specific-hospitalization-period (SHP), and principal diseases E11.5, E11.6 and E11.7. There were surprisingly large differences in ALOS among hospitals even after eliminating the influence of characteristics and conditions of patients. We then analyzed daily medical expenditure (DME) by the ordinary least squares methods. The variables that affected DME were LOS, number of comorbidities and complications, acute hospitalization, hospital’s own outpatient, season, introduced by another hospital, one-week hospitalization, 2010 revision, SHP, time trend, and principal diseases E11.2, E11.4 and E117. The DME did not decrease after the SHP. After eliminating the influences of characteristics and conditions of patients, the differences among hospitals were relatively small, 12% of the overall average. LOS is the main determinant of medical expenditures, and new incentives to reduce LOS are needed to control Japanese medical expenditures. Since at least 99% of patients require medical care after leaving the hospital, systems that take proper care of patients for long periods of time after hospitalization are absolutely necessary for efficient treatment of diabetes.

Study on Medical Expenditure Burden of Older People in China

Differences in level of medical expenditures and compensation ratio of medical expenditure among various subgroups in the older population according to age, gender, education, income and area have important public policy implications. This paper discusses these topics by data based on two waves of social surveys, a baseline in 2000 and a follow-up in 2006 named ＂The Sample Survey on Aged Population in Urban/Rural China （SSAPUR）＂. During the six years, the increasing speed of medical expenditure is rapid. The payout of medical expenditure of older people in 2000 was more conservative than that in 2006. Gender and urban-rural differences were also evident with regard to the compensation ratio of medical expenditure; older males and all urban older people had higher compensation ratios than elderly females and the rural older people, respectively. Compensation ratio also increased at age, as well as at education and income levels. Inequalities increased over the six-year period between surveys except when analyzed by area of residence and income levels. A comparison of factors affecting medical expenditure showed that the differences in medical expenditure between 2000 and 2006 had increased, though the influencing factors seemed to have become more reasonable.

The Impact of Population Aging on the Expenditure of Medical Insurance Fund for Urban Workers in China

Objective To explore the impact of population aging on the expenditures of medical insurance funds against the background that great changes in population structure influences economic development.Methods Through analyzing the impact of the population aging,the income and accumulated balance of the medical insurance fund,and other related factors on the expenditure of the medical insurance fund,development status of the medical insurance fund for urban employees in China since 2003 was obtained.Stata 16.0 was used to perform multiple linear regression analysis on related factors to determine the correlation between population aging and the change in medical insurance expenditures.Results and Conclusion The factors that have a greater impact on the expenditure of the medical insurance fund are the amount of income from the medical insurance,followed by the number of people over the age of 65 in China and the urban retired employees participating in medical insurance.We should focus on the sustainable development of the urban employee medical insurance fund to deal with the threat of aging.

A Preliminary Study on the Medical Expenditure of Chinese Medicine and Integrative Medicine Treatment for Influenza A (H1N1) in the Fever Clinics

Objective： To analyze the effectiveness of Chinese medicine and integrated Chinese and Western medicine for influenza A （H1N1） in the fever clinics and its relevant expenditure.Methods： A prospective survey on the clinical epidemic observation and follow-up was conducted from July 2009 to October 2009 with a self-developed questionnaire whose contents including the clinical data of the confirmed 149 H1N1 cases and their relevant therapeutic expenditure.The patients were assigned to the Chinese medicine group （22 cases treated by Chinese medicine alone） and integrative medicine group （124 cases treated by both Chinese medicine and Western medicine）.The data were processed with descriptive analysis,t test and χ 2 ,and sumrank test.Results： The proportion of clinical recovery of Chinese medicine group （81.8%） was higher than that of integrative medicine group （54.8%） with statistical significance （P=0.02）.The average fever durations in both groups were 3.5 to 4 days,showing no significant difference （P=0.86）.In the comparisons of average cost of Chinese herbs,drugs,therapies,and total cost,those of the Chinese medicine group were lower than those in the integrative group （P=0.01,P=0.00,P=0.00,P=0.00）.Conclusions： The H1N1 patients in the fever clinic who received Chinese medicine treatment had a higher clinical recovery proportion than those who received integrated Chinese and Western medicine treatment with lower medical cost.However,due to small sample size of the Chinese medicine group in the study,the conclusion needs further confirmation by studies with large sample size.

Effect of the new maternity insurance scheme on medical expenditures for caesarean delivery in Wuxi, China： a retrospective pre/post-reform case study

Aiming to control rising medical expenditures and help improve China＇s healthcare systems, this study examined whether a cap-based medical insurance scheme with shared financial interest between the insurance and healthcare providers is effective in containing hospitals＇ C-section medical expenditures. We used 6547 caesarean delivery case records from a teaching tertiary-level general public hospital located in Wuxi, China （2004-2013）, and used the Chow test to investigate the possibility of significant variation in mean medical expenditures for caesarean deliveries pre- and post-reform. We also used paired sample t-tests and linear regression models to compare the mean medical expenditures between insured and uninsured women undergoing caesarean delivery during the post-reform period. After the scheme＇s implementation, medical expenditures for caesarean deliveries declined and the medical expenditures of women covered by the scheme were significantly lower than those of uninsured patients. These findings indicated the scheme＇s effectiveness in minimizing caesarean delivery expenditures. The cap-based medical insurance scheme with shared financial interest between insurance and healthcare providers would likely steer healtbcare providers＇ behaviors in a more cost-effective direction.

Path Analysis on Medical Expenditures of 855 Patients with Chronic Kidney Disease in a Hospital in Beijing

Background： Investigate into the medical expenditures of chronic kidney disease （CKD） patients through path analysis method of three consecutive years within a Grade-A tertiary hospital in Beijing to conduct the main influencing factors in diagnosis-related groups （DRGs） grouping of the diagnosis, and reassess the present grouping process to provide information and reference on cost control for hospitals and medical management departments. Methods： Eight hundred and fifty-five inpatient cases whose first diagnosis were defined as CKD in the year 2014-2016 within the hospital were selected as the sample of the study, multiple linear regression and path analysis method were adopted in DRGs grouping process to investigate the main influencing factors of total medical expenditures and DRGs grouping process. Results： The maximum proportion of the medical costs within CKD patients was the costs on treatment, with the highest of 35.3% on the year 2014, the second was the costs on drug, which accounted for 〈30% during consecutive years, and the third was the costs on examination, which accounted for about 20% on average. The main influencing factors of medical expenditures included the type of dialysis, length of hospitalization, the admission of Intensive Care Unit （ICU）, and so on. The coefficients toward the effect for total costs were 0.416, 0.376, and 0.094. respectively. Conclusions： It is suggested that the type of dialysis and the admission of ICU were the major influencing factors of inpatient medical expenditures on CKD patients, and should be taken into consideration into the reassessment of DRGs grouping process to realize the localization and generalization of prospective payment system based on DRGs within the regional area and promote the implementation of medical cost control measures to reduce the economic burdens among patients and the society.

Regional Differences in Specific Health Examination Utilization and Medical Care Expenditures in Japan

Background: Despite having one of the most successful health systems in the world, annual medical expenditures in Japan have been increasing year to year. We sought to clarify regional differences in medical expenditures by analyzing the relationship between the specific health examination coverage and medical care expenditure by prefecture of Japan. Methods: We used data from the National Database of Health Insurance Claims and Specific Health Checkups (NDB) Open Data Japan (2015) and Overview of 2015 National Medical Expenses to compare medical care expenditure per capita and proportions of persons receiving specific health examination between Japan nationally and individual prefectures. Results: National medical expenditures were 42.3 trillion Japanese yen (JPY) (3851 hundred million dollars), with a national per capita rate of JPY347,219 (USD3156). Per capita medical expenditure rates by prefecture ranged from JPY290,900 (USD2645) in Saitama Prefecture to JPY 444,000 (USD4036) in Kochi Prefecture. The proportion of persons receiving specific health examinations was 49.0% for Japan overall and ranged from 39.3% in Hokkaido Prefecture to 63.4% in Tokyo Prefecture. We observed a significant negative correlation between per capita medical expenditures and the proportion of persons receiving specific health examinations (R = 0.553, p < 0.001). Conclusion: We found a significant negative correlation between per capita medical expenditures and the proportion of persons receiving health examinations: prefectures with lower expenditures tended to have higher rates of medical examinations. Interventions to increase the proportion of persons receiving specific health examinations by prefecture could reduce per capita medical expenditures and reduce prefectural disparities in expenditures.

No expenditure difference among patients with liver cancer at stageⅠ-ⅣV:Findings from a multicenter cross-sectional study in China

Objective:The number of liver cancer patients in China accounts for more than half of the world.However,China currently lacks national,multicenter economic burden data,and meanwhile,measuring the differences among different subgroups will be informative to formulate corresponding policies in liver cancer control.Thus,the aim of the study was to measure the economic burden of liver cancer by various subgroups.Methods:A hospital-based,multicenter and cross-sectional survey was conducted during 2012・2014,covering 39 hospitals and 21 project sites in 13 provinces across China.The questionnaire covers clinical information,sociology,expenditure,and related variables.All expenditure data were reported in Chinese Yuan(CNY)using 2014 values.Results:A total of 2,223 liver cancer patients were enrolled,of whom 59.61%were late-stage cases(III-IV),and 53.8%were hepatocellular carcinoma.The average total expenditure per liver cancer patient was estimated as 53,220 CNY,including 48,612 CNY of medical expenditures(91.3%)and 4,608 CNY of non-medical expenditures(8.7%).The average total expenditures in stage I,H,m and stage IV were 52,817 CNY,50,877 CNY,50,678 CNY and 54,089 CNY(P>0.05),respectively.Non-medical expenditures including additional meals,additional nutrition care,transportation,accommodation and hired informal nursing were 1,453 CNY,839 CNY,946 CNY,679 CNY and 200 CNY,respectively.The one-year out-of-pocket expenditure of a newly diagnosed patient was 24,953 CNY,and 77.2%of the patients suffered an unmanageable financial burden.Multivariate analysis showed that overall expenditure differed in almost all subgroups(P<0.05),except for sex,clinical stage,and pathologic type.Conclusions:There was no difference in treatment expenditure for liver cancer patients at different clinical stages,which suggests that maintaining efforts on treatment efficacy improvement is important but not enough.To fiirtherly reduce the overall economic burden from liver cancer,more effort should be given to primary and secondary prevention strategies.

Clinical application of subjective global assessment in Chinese patients with gastrointestinal cancer

AIM： To investigate the role of subjective global assessment （SGA） in nutritional assessment and outcome prediction of Chinese patients with gastrointestinal cancer. METHODS： A total of 751 patients diagnosed with gastrointestinal cancer between August 2004 and August 2006 were enrolled in this study. Within 72 h after admission, SGA, anthropometric parameters, and laboratory tests were used to assess the nutritional status of each patient. The outcome variables including hospital stay, complications, and in-hospital medical expenditure were also obtained.RESULTS： Based on the results of SGA, 389 （51.8%）, 332 （44.2%）, and 30 （4.0%） patients were classified into well nourished group （SGA-A）, mildly to moderately malnourished group （SGA-B）, and severely malnourished group （SGA-C）, respectively. The prevalence of malnutrition classified by SGA, triceps skinfold thickness （TSF）, mid-upper arm muscle circumference （MAMC）, albumin （ALB）, prealbumin （PA）, and body mass index （BMI） was 48.2%, 39.4%, 37.7%, 31.3%, 21.7%, and 9.6%, respectively. In addition, ANOVA tests revealed significant differences in body mass index （BMI）, TSF, PA, and ALB of patients in different SGA groups. The more severely malnourished the patient was, the lower the levels of BMI, TSF, PA, and ALB were （P 〈 0.05）. x^2 tests showed a significant difference in SGA classification between patients receiving different types of treatment （surgery vs chemotherapy/radiotherapy）. As the nutritional status classified by SGA deteriorated, the patients stayed longer in hospital and their medical expenditures increased significantly. Furthermore, multiple regression analysis showed that SGA and serum ALB could help predict the medical expenditures and hospital stay of patients undergoing surgery. The occurrence of complications increased in parallel with the increasing grade of SGA, and was the highest in the SGA-C group （23.3%） and the lowest in the SGA-A group （16.8%）. CONCLUSION： SGA is a reliable assessment too and helps to predict the hospital stay and medica expenditures of Chinese surgical gastrointestina cancer patients.