Utilization and cost of inpatient care and their determinants among rural residents in Ji'nan city

Objective To examine the utilization and cost of inpatient care and their determinants among rural residents in Ji'nan municipality,Shandong province and to provide evidence for rational utilization and cost control of inpatient care.Methods Three counties of Ji'nan municipality were selected with stratified random sampling method and 3 458 residents were surveyed.Results In 2006 and 2008,the proportion of inpatients among the rural residents was 4.89% and 3.90%.Hospitalization cost for per admission was 6 385.74 RMB yuan and 7127.08 RMB yuan,with the ratios of reimbursement from NewRural Cooperative Medical System(NCMS)of 10.99% and 12.84%.The univariate analyses showed that the utilization rate of inpatient care was significantly different among the inpatients with different gender,age,occupation,educational level,self-assessed health status,and smoking and alcohol drinking habits(P<0.05 for all)and the rate was not significantly different among the inpatients from different counties and with different income(P>0.05).The multivariate analyses showed that worse self-assessed health status was a risk factor for the utilization rate of inpatient care,while at age of 15 to 24 years was a protective factor.The key determinants of inpatient care costs included length of stay(LOS),the amount of reimbursement from NCMS,the level of the hospitalized facilities,the category of diseases that caused the hospitalization,and the residential county of the inpatients.Conclusion Among rural residents in Ji'nan city,the utilization rate of inpatient care was lowwhile the cost was high,and the reimbursement for the cost from NCMS was limited.Rationalizing the distribution of inpatients in different levels of hospitals,shortening LOS,and improving the compensatory ability of NCMS are the key points to the control of hospitalization cost and for the alleviation of financial burden for rural inpatients.