Analysis of factors influencing hospitalization cost and medical security level of patients with bronchial and pulmonary malignant tumors - a retrospective study in Changzhi, China

Abstract Background The financial burden of medical expenses for patients with bronchial and pulmonary malignancies in coal-abundant regions poses a significant challenge. This study examines the variations in medical costs among patients with diverse characteristics and analyzes the distribution of expenses across different healthcare settings, thereby laying the foundation for the rational management of medical expenditures. Additionally, this research evaluates the adequacy of local medical insurance systems in supporting patients with bronchial and pulmonary malignancies, offering insights to improve the equity of medical insurance coverage. Methods A total of 4,930 hospitalized patients with bronchial and pulmonary malignant tumors were identified from the Changzhi Medical Insurance Center records between January 2018 and June 2022. After transforming the skewed quantitative data on total medical costs, we conducted a cost composition analysis and a single-factor analysis. A BP neural network was subsequently employed to identify the influencing factors and evaluate the medical security level. Results Among the total costs, the five highest sub-cost categories were drug costs (31.76%), diagnosis and treatment costs (22.10%), examination costs (21.10%), consumable costs (19.20%), and comprehensive medical service costs (3.45%). Gender, surgical intervention, patient transfer, and hospital level exerted statistically significant effects on total medical costs ( P < 0.05); among these, the three most influential factors were length of hospital stay (0.245), hospital grade (0.208), and surgical intervention (0.165). The actual compensation ratio in secondary-level medical institutions (mean 78.81%) was higher than that observed in tertiary-level medical institutions (mean 68.85%). Conclusion Drug and consumable costs accounted for the highest proportion of the total costs. It is an effective measure to reduce the economic burden of patients by controlling the use of drugs and consumables, effectively monitoring the proportion of drug expenditure and diagnosis and treatment costs, appropriately increasing the salary of nursing staff, reasonably shortening the length of hospital stay, and improving the fairness of medical insurance reimbursement rate.