Analysis of influencing factors on the individual and pooling funds payment of medical insurance patient

OBJECTIVE To study the influencing factors on the individual and pooling funds payment of medical insurance cirrhosis inpatient in Tianjin so as to explore the perfect tactics of reducing medical expense and offer the theoretic and practical evidence for establishing effective expense control mechanism. METHODS 2 341 cirrhosis inpatients with medical insurance from 2003 to 2007 were collected randomly from the database, the hospitalization expenses of individual payment and pooling funds payment constitution were analyzed. Compared among groups with the nonparametric test, the influencing factors of the expense of two different payment methods were analyzed by multiple linear regression method. RESULTS Length of stay, hospital level and the way of treatment were the main factors affecting the funds payment, the factors influencing individual payment were the same as funds payment, apart from the occupation. The expense of individual payment and funds payment were positively correlated with the number of hospitalization days, the grade of the hospital and the ratio of operation fee. Individual payment in in-service staff was higher than that in retirees. CONCLUSION Government, hospitals and medical insurance institutions need a concerted effort. Effective measures, such as instituting the charge criterion of specific entity based on common therapeutic standard, considering factors such as age, patient’s condition and the way of treatments at the same time should be taken to reduce the individual payment and pooling funds payment of cirrhotic patients.