3.1 Malignant neoplastic disease cost scale
The 2019 total treatment cost of malignant tumor in Hunan province was 44,659.68 ten thousand yuan, which accounted for 2.96% of the total treatment cost in Hunan Province[10]. 58.61 ten thousand yuan for outpatient expenses, which accounted for 0.13% of the treatment cost of malignant tumor. And hospitalization cost was 44601.07 ten thousand yuan, which accounted for 99.87% of the treatment cost of the malignant tumor.
3.2 Disease distribution of malignant tumor treatment expense
As shown in Table1, the top five of malignant tumor treatment costs in Hunan Province in 2019 were malignant tumors of digestive organs(40.10%), malignant tumors of respiratory and intrathoracic organs (17.62%), malignant tumors of the breast (12.24%), malignant tumors of female genital organs (9.88%) and malignant tumors of the lip, mouth, and pharynx (6.87%), above-mentioned malignant tumors occupy 86.71% of the treatment cost of malignant tumors. The disease distribution of inpatient and outpatient costs is consistent with the distribution of treatment costs. Among outpatient costs, malignant tumor of breast and female reproductive organs accounted for a considerable proportion, 33.15% and 27.63% respectively. The highest proportion of hospitalization expenses was 40.24% for malignant tumors of digestive organs, while respiratory and intrathoracic organ malignant tumors ranked second, accounting for 17.67%. (Table 1)
Table 1
Disease distribution of malignant tumor treatment costs in Hunan province in 2019
Disease type | Treatment cost (ten thousand yuan) | Composition(%) | Outpatient cost(ten thousand yuan) | Composition(%) | Hospitalization cost(ten thousand yuan) | Composition(%) |
digestive organs | 17954.36 | 40.20 | 7.18 | 12.26 | 17947.18 | 40.24 |
respiratory and intrathoracic organs | 7886.51 | 17.66 | 7.15 | 12.21 | 7879.36 | 17.67 |
lip, mouth and pharynx | 3077.34 | 6.89 | 4.45 | 7.60 | 3072.89 | 6.89 |
breast | 5479.13 | 12.27 | 19.41 | 33.15 | 5459.72 | 12.24 |
female genital organs | 4423.74 | 9.91 | 16.18 | 27.63 | 4407.56 | 9.88 |
male genital organs | 1181.22 | 2.64 | 1.15 | 1.96 | 1180.07 | 2.65 |
bone and articular cartilage | 104.06 | 0.23 | 0.16 | 0.27 | 103.90 | 2.32 |
urinary system | 1270.49 | 2.84 | 1.43 | 2.44 | 1269.06 | 2.85 |
mesothelial tissue and soft tissue | 294.56 | 0.66 | 0.17 | 0.29 | 294.39 | 0.66 |
eye, brain and central nervous system | 470.98 | 1.05 | 0.11 | 0.19 | 470.87 | 1.06 |
lymphatic, hematopoietic and related tissues | 13.70 | 0.03 | 0.01 | 0.02 | 13.69 | 0.03 |
Unspecified, secondary and other unspecified | 457.27 | 1.02 | 1.13 | 1.93 | 456.14 | 0.10 |
thyroid and other endocrine glands | 2046.255 | 4.58 | 0.03 | 0.05 | 2046.23 | 0.46 |
3.3 Age distribution of malignant tumor treatment expense
The treatment expenses are mainly based on hospitalization expenses in different age groups, the total cost of hospitalization was 44601.07 ten thousand yuan, the outpatient cost was 58.61 ten thousand yuan and the 35-59 and 60-79 age groups accounted for a significant proportion, 43.98% and 48.11% respectively. The disease expenses distribution of hospitalization and outpatient is consistent with the treatment expenses, accounting for a higher proportion in 35-59 and 60-79 age groups, and the combined percentage of this two groups reached 95.22% and 92.09%. Their outpatient and hospitalization expenses are higher than the other age groups. The shares of people under 35 years old and over 80 years old are smaller. (Table 2)
Table 2
Age distribution of malignant tumor treatment cost in Hunan province in 2019
Age group | Treatment cost(ten thousand yuan) | Composition(%) | Outpatient cost(ten thousand yuan) | Composition(%) | Hospitalization cost(ten thousand yuan) | Composition(%) |
0-14 | 49.94 | 0.1 | 0.38 | 0.63 | 49.57 | 0.11 |
15-34 | 1107.12 | 2.48 | 0.87 | 1.48 | 1106.25 | 2.48 |
35-59 | 19641.06 | 43.98 | 31.38 | 53.78 | 19609.54 | 43.97 |
60-79 | 21485.67 | 48.11 | 24.29 | 41.44 | 21461.38 | 48.12 |
Over 80 | 2375.89 | 5.32 | 1.56 | 2.66 | 2374.33 | 0.53 |
Total | 44659.68 | 100 | 58.61 | 100 | 44601.07 | 100 |
3.4 Institution distribution of malignant tumor treatment cost
From the institutional configuration of costs, the treatment expenses of a malignant tumor are mainly concentrated in general hospitals, accounting for as much as 85.46%, and it’s treatment cost mainly concentrated in hospitalization expense. Maternal and child health hospitals ranked the second, accounting for 5.57%, followed by Chinese medicine hospital accounting for 4.6%, the proportion of specialized hospital is low, accounting for 2.86%, and primary health care institutions have the lowest percentage of oncology treatment cost, only 1.50%. (Table 3)
Table 3
Institution distribution of malignant tumor treatment cost in Hunan province in 2019
Institution | Amount(ten thousand yuan) | Proportion (%) | Outpatient cost (ten thousand yuan) | Proportion (%) | Hospitalization cost (ten thousand yuan) | Proportion(%) |
Chinese medicine hospital | 2054.95 | 4.60 | 2.45 | 4.18 | 2052.50 | 4.60 |
Maternal and child health hospital | 2487.33 | 5.57 | 13.03 | 22.23 | 2474.30 | 5.55 |
General hospital | 38166.56 | 85.46 | 5.32 | 9.07 | 38161.24 | 85.56 |
Specialized hospital | 1278.98 | 2.86 | 0.17 | 0.29 | 1278.81 | 2.87 |
Primary health care institution | 671.86 | 1.50 | 37.64 | 64.22 | 634.22 | 1.42 |
3.5 Components of funding program for malignancy treatment cost
The treatment expenses of malignant tumors in Hunan province were mainly from the government program funding accounting for 60.78%, the mandatory medical program accounted for a considerable proportion(53.91%); the household health expenditure also accounted for a relatively high proportion, 34.3%, and the share of voluntary health care payment program was low, only 4.92%. (Table 4)
Table4 Components of funding program for malignancy treatment cost in Hunan province in 2019
Funding program | Billion | Proportion(%) |
Government program and mandatory health financing program | 43.86 | 60.78 |
Government program | 4.96 | 6.87 |
Mandatory health insurance program | 38.9 | 53.91 |
Voluntary health cure payment program | 3.55 | 4.92 |
Voluntary health insurance program | 3.25 | 4.50 |
Funding programs for non-profit institutions providing services to households | 0.18 | 0.25 |
Enterprise financing program | 0.12 | 0.17 |
Family health expenditure | 24.75 | 34.30 |
3.6 Disease distribution of malignant tumor treatment cost in different age groups
The disease distribution of malignant tumors in different age groups has different features. Among them: the treatment cost of malignant tumors in the 0-14 age group accounted for a considerable proportion(61.7%) in the malignant tumors of the eye, brain and central nervous system; the treatment cost in the 15-34 age group mainly concentrated in malignant tumors of digestive organs (26.5%), malignant tumors of the breast (20.14%), malignant tumors of female genital organs (15.33%), and thyroid and other endocrine glands (15.85%); From the age distribution of disease, malignant tumors of the breast and malignant tumors of the female genital organs accounted for a larger proportion in the age groups of 15-34 and 35-59 years old, with a combined proportion of 35.47% and 34.69%, respectively. The malignant tumor treatment costs in 60-79 and over 80 age groups have the same disease distribution, the malignant tumors of digestive organs accounted for a significant proportion, 47.18% and 43.02% respectively, followed by respiratory and intrathoracic organ malignancies; It is noteworthy that the proportion of treatment costs for malignant tumors of male genital organs in the age group of 80 years or older was the highest among all age groups (15.90%). (Table 5)
Table5 Disease distribution of malignant tumor treatment cost in different age groups in Hunan province in 2019
Disease category | 0-14 | 15-34 | 35-59 | 60-79 | Over 80 |
Expense (ten thousand yuan) | Composition(%) | Expense (ten thousand yuan) | Composition(%) | Expense (ten thousand yuan) | Composition(%) | Expense (ten thousand yuan) | Composition(%) | Expense (ten thousand yuan) | Composition(%) |
digestive organs | 7.62 | 15.42 | 293.23 | 26.50 | 6493.68 | 33.06 | 10137.74 | 47.18 | 1022.09 | 43.02 |
respiratory and intrathoracic organs | 0.76 | 1.54 | 36.85 | 3.33 | 2600.55 | 13.24 | 4835.73 | 22.51 | 412.70 | 17.37 |
lip, mouth and pharynx | 3.23 | 6.54 | 97.46 | 8.80 | 1702.46 | 8.67 | 1219.75 | 5.68 | 54.45 | 2.29 |
breast | 0.05 | 0.10 | 222.89 | 20.14 | 4047.81 | 20.61 | 1155.23 | 5.38 | 53.16 | 2.24 |
female genital organs | 1.29 | 2.61 | 169.77 | 15.33 | 2765.35 | 14.08 | 1450.14 | 6.75 | 37.19 | 1.57 |
male genital organs | 0.02 | 0.04 | 4.17 | 0.38 | 120.29 | 0.61 | 678.55 | 3.16 | 377.69 | 15.90 |
bone and articular cartilage | 0.47 | 0.95 | 12.77 | 1.15 | 24.91 | 0.13 | 54.45 | 2.53 | 11.45 | 0.48 |
urinary system | 0.32 | 0.65 | 32.54 | 2.94 | 339.03 | 1.73 | 704.00 | 3.28 | 194.60 | 8.19 |
mesothelial tissue and soft tissue | 0.93 | 1.88 | 13.94 | 1.26 | 132.10 | 0.67 | 129.26 | 0.60 | 18.34 | 0.77 |
eye, brain and central nervous system | 30.49 | 61.70 | 41.92 | 3.79 | 242.48 | 1.23 | 106.17 | 4.94 | 49.92 | 2.10 |
lymphatic, hematopoietic and related tissues | 0 | 0 | 0 | 0 | 2.87 | 0.01 | 10.44 | 0.49 | 0.40 | 0.02 |
Unspecified, secondary and other unspecified | 0.74 | 1.50 | 6.09 | 0.55 | 173.81 | 0.88 | 226.42 | 1.05 | 50.21 | 2.11 |
thyroid and other endocrine glands | 3.50 | 7.08 | 175.52 | 15.85 | 995.72 | 0.51 | 777.80 | 3.62 | 93.71 | 3.94 |
3.7 Disease distribution of malignant tumor treatment cost by gender
Between the male and female disease distribution, the treatment expenses of malignant tumors of digestive organs are in the top position, which accounted for 49.05% and 29.94% respectively. The malignant tumors of respiratory and intrathoracic organs also accounted for a large proportion(24.51%) in males, followed by malignant tumors of the lip, mouth and pharynx(10.24%) and malignant tumors of male genital organs(4.92%). The second most common malignant tumor in women is breast cancer, reached 26.4%, the proportion of malignant tumors of female genital organs is alsohigh( 21.4%). Totally, except for the malignant tumors of the breast and malignant tumors of the female genital organs, treatment costs for other diseases are higher for men than for women. (Table 6)
Table 6
Disease distribution of malignant tumor treatment cost by gender in Hunan province in 2019
Disease category | Total (ten thousand yuan) | Composition (%) | Male(ten thousand yuan) | Composition(%) | Female (ten thousand yuan) | Composition(%) |
digestive organs | 17954.37 | 40.2 | 11766.27 | 49.05 | 6188.1 | 29.94 |
respiratory and intrathoracic organs | 7886.51 | 17.66 | 5880.1 | 24.51 | 2006.41 | 9.71 |
lip, mouth and pharynx | 3077.35 | 6.89 | 2456.86 | 10.24 | 620.49 | 3 |
breast | 5479.13 | 12.27 | 21.01 | 0.09 | 5458.12 | 26.4 |
female genital organs | 4423.73 | 9.91 | 0 | 0 | 4423.73 | 21.4 |
male genital organs | 1181.23 | 2.65 | 1181.23 | 4.92 | 0 | 0 |
bone and articular cartilage | 104.05 | 0.23 | 59.2 | 0.25 | 44.85 | 0.22 |
urinary system | 1270.48 | 2.85 | 969.41 | 4.05 | 301.07 | 1.46 |
mesothelial tissue and soft tissue | 294.56 | 0.66 | 203.91 | 0.85 | 90.65 | 0.44 |
eye, brain and central nervous system | 470.98 | 1.05 | 214.51 | 0.89 | 256.47 | 1.24 |
lymphatic, hematopoietic and related tissues | 13.77 | 0.03 | 12.63 | 0.05 | 1.14 | 0 |
Unspecified, secondary and other unspecified | 457.27 | 1.02 | 270.37 | 1.13 | 186.9 | 0.9 |
3.8 Distribution of malignant tumor treatment cost in different hospitals
As can be seen from the table, the treatment expenses in Chinese medicine hospitals, general hospitals, specialization hospitals and primary medical and health institutions are mainly concentrated in two major diseases: malignant tumors of digestive organs and malignant tumors of respiratory and intrathoracic organs, and the sum of the proportion is above 50%. The most treatment expenses are respiratory and intrathoracic organ malignancies in the Chinese medicine hospital, accounting for 35.42%, followed by the malignant tumors of digestive organs 27.7%. The treatment cost of malignant tumor of breast and malignant tumor of female reproductive organs in maternal and child health hospitals is higher, accounting for 53.4% and 45.38% of the total cost respectively; the treatment cost of malignant tumor of digestive organs in general hospitals ranks first, accounting for 47.14%, followed by 18.18% of malignant tumor of respiratory and thoracic organs and 10.21% of malignant tumor of the breast; the top two treatment costs in specialty hospitals are respiratory and intrathoracic malignant tumors and digestive malignant tumors; the higher treatment costs in primary health care institutions are digestive malignant tumors and respiratory and intrathoracic malignant tumors, accounting for 52.39% of the total. It is noteworthy that the treatment costs of all categories of malignant tumors mainly concentrated in general hospitals. (Table 7)
Table7 Distribution of malignant tumor treatment cost in different hospitals in Hunan province in 2109
Disease category | Chinese medicine hospital | Maternal and child health hospital | General hospital | Specialized hospital | Primary health cure institution |
Expense (ten thousand yuan) | Composition(%) | Expense (ten thousand yuan) | Composition(%) | Expense (ten thousand yuan) | Composition(%) | Expense (ten thousand yuan) | Composition(%) | Expense (ten thousand yuan) | Composition(%) |
digestive organs | 569.38 | 27.7 | 1.54 | 0.06 | 18279.77 | 47.14 | 324.33 | 25.36 | 201.58 | 30.00 |
respiratory and intrathoracic organs | 727.83 | 35.42 | 4.27 | 0.17 | 7049.62 | 18.18 | 436.82 | 34.15 | 150.45 | 22.39 |
lip, mouth and pharynx | 199.943 | 9.73 | 0.45 | 0.02 | 2854.83 | 7.36 | 68.47 | 5.35 | 11.36 | 1.69 |
breast | 141.71 | 6.9 | 1328.19 | 53.4 | 3958.06 | 10.21 | 32.48 | 2.54 | 42.56 | 6.33 |
female genital organs | 127.52 | 6.21 | 1128.66 | 45.38 | 3088.15 | 7.96 | 108.46 | 8.48 | 94.72 | 14.10 |
male reproductive organs | 94.199 | 4.58 | 0.53 | 0.02 | 898.91 | 2.32 | 111.64 | 8.73 | 104.63 | 15.57 |
lymphatic, hematopoietic and related tissues | 1.35 | 0.07 | 1.33 | 0.05 | 89.34 | 0.23 | 26.89 | 2.10 | 1.01 | 0.15 |
Unspecified, secondary and other unspecified | 56.41 | 2.73 | 16.4 | 0.66 | 381.33 | 0.98 | 64.68 | 5.06 | 4.15 | 0.62 |
thyroid and other endocrine glands | 6.69 | 0.33 | 5.92 | 0.24 | 860.13 | 2.22 | 10.84 | 0.85 | 26.66 | 3.97 |
Others | 129.92 | 6.33 | 0.044 | 0 | 1315.52 | 3.39 | 94.37 | 7.38 | 34.74 | 5.17 |
(Note: Others include malignant tumors of bone and articular cartilage, malignant tumors of the urinary system, malignant tumors of the eye, brain and central nervous system)
3.9 Analysis of factors influencing the hospitalization cost
Taking the total hospitalization cost as a dependent variable, age, number of days in the hospital, gender, the proportion of medicine, institution level and the type of medical institution were assigned as independent variables. Because the hospitalization expense did not comply with the normal distribution, it needed to be logarithmically converted[11]. (Table 8)
Table8 Variable assignment
Variable | Influence factors | Assignment |
Y | Total hospitalization cost | Logarithmic conversion |
X1 | Age | 0=<=14,1=15-34,2=35-59,3=60-79,4=>=80 |
X2 | Number of days in hospital | Actual value |
X3 | Gender | 1=male, 2=female |
X4 | Drug share(%) | Actual value |
X5 | Institution level | 1=provincial, 2=Municipal, 3=District, 4=County |
X6 | Medical institution level | 1=Chinese medicine hospital, 2=Maternal and child health hospital, 3=General hospital, 4=Specialized hospital, 5=Primary health cure institution |
Take age, institution level and the type of medical institution as dummy variables, the age group in 35-59 as a reference, institution-level with provincial as a reference, the type of medical institution with the general hospital as reference[12]. Results show the hospitalization costs were higher with a long hospitalization day (β = 0.313) and high drug-to-patient ratio (β = 0.067), the difference between men and women in hospitalization costs has statistical significance; the hospitalization costs for the age group over 80(β=-0.018) were lower than the 35-59 age group, the hospitalization costs for the age group 60-79(β = 0.028) were higher than the 35-59, municipal (β = -0.05) and district (β = -0.291) hospitalization costs were lower than those at the provincial level; specialty hospitals (β = -1.089) and primary health care institutions (β=-3.562) hospitalization costs were lower than those at general hospitals. (Table 9)
Table9 Multiple linear regression analysis of factors influencing hospitalization costs of patients with malignancy in Hunan province in 2019
Independent variable | Partial regression coefficient | Standard error | Standard partial regression coefficient | t value | P |
(Constant) | 9450.531 | 332.883 | | 28.39 | <0.01 |
Gender | 1516.15 | 181.341 | 0.036 | 8.361 | <0.01 |
Hospitalization days | 396.41 | 5.52 | 0.313 | 71.809 | <0.01 |
Drug share | 5995.408 | 388.41 | 0.067 | 15.436 | <0.01 |
Age(35-59as reference) |
0-14 | 733.14 | 1196.729 | 0.003 | 0.613 | 0.54 |
15-34 | 220.309 | 566.201 | 0.002 | 0.389 | 0.697 |
60-79 | 1194.816 | 200.554 | 0.028 | 5.958 | <0.01 |
Over 80 | -1746.761 | 457.958 | -0.018 | -3.814 | <0.01 |
Institution level(provincial as reference) |
Municipal | -2086.839 | 453.649 | -0.05 | -4.6 | <0.01 |
District | -14630.867 | 477.546 | -0.291 | -30.638 | <0.01 |
County | 716.42 | 480.039 | 0.014 | 1.492 | 0.136 |
Medical institution category(general hospital as reference) |
Chinese medicine hospital | 36111.61 | 341.670 | 0.987 | 2.587 | <0.01 |
Maternal and child health hospital | 35679.23 | 128.965 | 0.975 | 1.324 | <0.01 |
Specialized hospital | -36887.58 | 468.443 | -1.008 | -1.089 | <0.01 |
Primary health cure institution | -37494.7 | 384.619 | -1.025 | -3.562 | <0.01 |
a. Dependent variable: Total amount |