Cost analysis of medical care.

Abstract

Information about medical and health care costs in Shanghai County are presented along with some comparisons of expenditures over time and between systems. In Shanghai County there are 4 primary sources of funds for medical and health services: direct government appropriation; contributions from factories and enterprises to the labor insurance system; commune and brigade contributions to the collective health systems; and individual contributions to the cooperative health system. The total identified amount of funds for medical and health services in Shanghai County in 1980 was 9350000 yuan (at the time this paper was written 1 yuan was approximately equivalent to US $0.60) of which 35% came directly from the government. The level of funding in 1980 was 2.6 times that in 1972. The greatest proportionate increase was in the category of administration yet expenditures for administration amounted to only 1-2% of total health expenditures both in 1972 and in 1980. The largest single category of expenditures in 1980 was for support of the County Central Hospital. Over the 1972-1980 period there was a 400% increase for the County Central Hospital expenditures. An analysis was made of the direct costs of care for patients hospitalized at the County Central Hospital for 14 selected conditions in 1980. The average length of stay for all admissions was 17.7 days with a range for the conditions studied from 5.8 days for infantile diarrhea to 52.2 days for radical surgery associated with gastric cancer. The identified direct costs/day of admission ranged from a low of 1.10 yuan for herniorrhaphy to a high of 10.00 yuan for ulcer surgery. The proportion of total direct costs which was spent for drugs used in management ranged from a low of 29.2% for herniorrhaphy to a high of 70.8% for bronchial asthma admissions. The drug costs accounted for 51.0% of direct costs for hospital care. Of the costs for hospitalization in the county hospital for residents of 162 brigades (68.1%) reimbursement was 50% or greater of the total cost. For hospitalization in the commune or town hospital level 99.2% of the brigades reimburse at least 50% of the cost (72.7% reimbursed 100% of cost). If prolonged hospitalization occurs with costs to the patient exceeding his/her ability to pay a high proportion of the cost is reduced or borne by the collective welfare fund.