Abstract:

Objective To investigate the effect of different health coverage on hospital expenditure of patients with acute myocardial infarction (AMI), and evaluate the effect of health insurance policy on control of hospital expenditure of patients with AMI in Shanghai. Methods The medical record home page information and health insurance payment information of 1 869 patients with AMI admitted to one tertiary comprehensive hospital in Shanghai between January 2007 and August 2012 were collected. With the reimbursement ratio as independent variable, total cost as dependent variable and the other related factors as controlled variables, univariate analysis and multivariate regression analysis were performed. Meanwhile, these patients were divided into two groups according to the time of change of health insurance policy, and the cost control effect after policy change was evaluated by rank correlation analysis. Results Insurance coverage was a main influencing factor of hospital expenditure, and the increase of reimbursement ratio led to the decrease of hospital expenditure in patients with AMI. The reimbursement ratio increased every 1%, the total hospital expenditure decreased 23.80 yuan, and the total hospital expenditure of patients treated with cardiac intervention decreased 30.13 yuan. The change of health insurance policy significantly released the economic burden on patients with AMI (P<0.000 1), but had no significant effect on total medical cost (P=0.087 4). Conclusion Compared with insurance type, the imbursement ratio is a more precise and sensitive variable to measure hospital expenditure. The government should properly adjust the reimbursement ratio, guide residents toward more rational medical consumption, and actively put forward payment reform.

Key words: acute myocardial infarction, hospital expenditure, insurance coverage, health insurance policy