Factors Affecting Patient Bill Amount in Hospitals

Öz

Patient bills are a significant indicator of healthcare expenditures. Many factors can influence patient bills. Identifying these factors can contribute to expense management. The purpose of this study is to identify the factors affecting patient bills in hospitals. To identify the factors affecting patient bills, patient admission data from a Training and Research Hospital between April 2020 and August 2021 was examined. Data from 27,215 individuals admitted to the hospital during this period was transferred to SPSS 22.0 and analyzed. Data analysis includ1ed the number, percentage, mean, standard deviation, and median values, and examined any differences between the groups. Regression analysis was conducted to identify the factors affecting patient bills. Age, gender, hospital stay, ICD-10 main diagnosis groups, and Covid-19 diagnosis were included as independent variables in the regression model. The regression analysis concluded that the established model was significant, and that patient age, gender, length of stay, and Covid-19 diagnosis all influenced hospital bills. Additionally, ICD diagnostic groups were found to affect the cost bill amount to varying degrees. The top five factors influencing the bill amount are perinatal diseases (P00-P96), injuries, poisoning, and other external causes (S00-T98), musculoskeletal and connective tissue diseases (M00-M99), circulatory system diseases (I00-I99), and factors affecting health status and healthcare utilization (Z00-Z99).

Anahtar Kelimeler

• Patient
• hospitalization
• ICD-10 main diagnosis
• bill amount

Hastanelerde Hasta Fatura Tutarına Etki Eden Faktörler

Öz

Hasta faturaları sağlık harcamalarının önemli bir göstergesidir. Hasta fatura tutarına birçok faktör etki edebilmektedir. Bu faktörlerin ortaya çıkarılması harcamaların yönetimi açısından önemlidir. Bu araştırmanın amacı hastanelerde hasta fatura tutarına etki eden faktörleri ortaya çıkarmaktır. Hasta fatura tutarına etki eden faktörleri ortaya çıkarmak için bir eğitim ve araştırma hastanesinin Nisan 2020-Ağustos 2021 dönemindeki hasta yatış verileri incelenmiştir. Bu dönemde hastaneye yatışı yapılmış 27.215 kişinin verisi SPSS 22.0 programına aktarılarak analiz edilmiştir. Verilerin analizinde; sayı, yüzde, ortalama, standart sapma, ortanca değerleri elde edilmiş ve gruplar arasında fark olup olmadığı incelenmiştir. Hasta fatura tutarını etkileyen faktörleri ortaya çıkarmak için regresyon analizi yapılmıştır. Regresyon modeline; yaş, cinsiyet, yatış süresi, ICD-10 ana tanı grupları ve Covid-19 tanısı bağımsız değişkenler olarak konulmuştur. Yapılan regresyon analizinde kurulan modelin anlamlı olduğu ve hastane fatura tutarına; hastanın yaşının, cinsiyetinin, yatış süresinin ve Covid-19 tanısının etkili olduğu sonucuna ulaşılmıştır. Ayrıca ICD 10 tanı gruplarının maliyetlerinin fatura tutarlarını farklı düzeylerde etkilediği belirlenmiştir. Fatura tutarına etkisi bakımından ilk beş sırada; perinatal dönemden kaynaklanan hastalıklar (P00-P96), yaralanma, zehirlenme ve dış nedenlere bağlı diğer durumlar (S00-T98), kas-iskelet ve bağ dokusu hastalıkları (M00-M99), dolaşım sistemi hastalıkları (I00-I99), sağlık durumu ve sağlık hizmetlerinden yararlanmayı etkileyen faktörler (Z00-Z99) yer almaktadır.

Anahtar Kelimeler

• Hasta
• hastaneye yatış
• ICD-10 ana tanısı
• fatura tutarı

Kaynakça

1. Ahnquist, J., Wamala, S. P. and Lindstrom, M. (2012). Social Determinants of Health–A Question of Social or Economic Capital? Interaction Effects of Socioeconomic Factors on Health Outcomes. Social Science and Medicine. 74(6). 930-939.
2. Alpar, R. (2022). Uygulamalı İstatistik ve Geçerlik-Güvenirlik. Ankara: Detay Yayıncılık.
3. Andersson, E., Persson, S., Hallén, N., Ericsson, Å., Thielke, D., Lindgren, P., ... and Jendle, J. (2020). Costs of Diabetes Complications: Hospital-Based Care and Absence from Work for 392,200 People with Type 2 Diabetes and Matched Control Participants in Sweden. Diabetologia. 63. 2582- 2594.
4. American Diabetes Association (2018). Economic Costs of Diabetes in the US in 2017. Diabetes Care. 41(5). 917-928.
5. Baharin, R. and Saad, S. (2018). Ageing Population and Health Care Expenditure: Evidence Using Time Series Analysis. Geografia. 14(4). 65-73.
6. Bähler, C., Huber, C. A., Brüngger, B. and Reich, O. (2015). Multimorbidity, Health Care Utilization and Costs in an Elderly Community-Dwelling Population: A Claims Data Based Observational Study. BMC Health Services Research. 15(23). 1-12.
7. Barro, R. J., Ursúa, J. F. and Weng, J. (2020). The Coronavirus and the Great Influenza Pandemic: Lessons from the “Spanish Flu” for the Coronavirus’s Potential Effects on Mortality and Economic Activity (No. w26866). National Bureau of Economic Research. Harvard University. Cambridge.
8. Bartsch, S. M., Ferguson, M. C., McKinnell, J. A., O’shea, K. J., Wedlock, P. T., Siegmund, S. S. and Lee, B. Y. (2020). The Potential Health Care Costs and Resource Use Associated with Covid-19 in the United States: A Simulation Estimate of the Direct Medical Costs and Health Care Resource Use Associated with Covid-19 Infections in the United States. Health Affairs. 39(6). 927-935.

9. Bensken, W. P., Alberti, P. M., Stange, K. C., Sajatovic, M. and Koroukian, S. M. (2022). ICD-10 Z-Code Health-Related Social Needs and Increased Healthcare Utilization. American Journal of Preventive Medicine. 62(4). e232-e241.
10. Bodilsen, J., Nielsen, P. B., Søgaard, M., Dalager-Pedersen, M., Speiser, L. O. Z., Yndigegn, T., ... and Skjøth, F. (2021). Hospital Admission and Mortality Rates for Non-Covid Diseases in Denmark During Covid-19 Pandemic: Nationwide Population Based Cohort Study. BMJ. 373. 1-10.
11. Chang, E., Ali, R., Seibert, J. and Berkman, N. D. (2023). Interventions to Improve Outcomes for High-Need, High-Cost Patients: A Systematic Review and Meta-Analysis. Journal of General Internal Medicine. 38(1). 185-194.
12. Chaturvedi, A., Zhu, A., Gadela, N. V., Prabhakaran, D. ve Jafar, T. H. (2024). Social Determinants of Health and Disparities in Hypertension and Cardiovascular Diseases. Hypertension. 81(3). 387-399.
13. Chukamei, Z. G., Mobayen, M., Toolaroud, P. B., Ghalandari, M. and Delavari, S. (2021). The Length of Stay and Cost of Burn Patients and the Affecting Factors. International Journal of Burns and Trauma. 11(5). 397- 405.
14. Erlangga, D., Suhrcke, M., Ali, S. and Bloor, K. (2019). The Impact of Public Health Insurance on Health Care Utilisation, Financial Protection and Health Status in Low-and Middle-Income Countries: A Systematic Review. Plos One. 14(8). e0219731.
15. Ferrari, G., Giannichi, B., Resende, B., Paiva, L., Rocha, R., Falbel, F., ... and Rezende, L. F. M. (2022). The Economic Burden of Overweight and Obesity in Brazil: Perspectives for the Brazilian Unified Health System. Public Health. 207. 82-87.
16. Gómez, C. A., Kleinman, D. V., Pronk, N., Gordon, G. L. W., Ochiai, E., Blakey, C., ... and Brewer, K. H. (2021). Addressing Health Equity and Social Determinants of Health Through Healthy People 2030. Journal of Public Health Management and Practice. 27(Supplement 6). 249-257.
17. Guilcher, S. J., Bronskill, S. E., Guan, J. and Wodchis, W. P. (2016). Who are the High-Cost Users? A Method for Person-Centred Attribution of Health Care Spending. PLoS One. 11(3). e0149179.
18. Gutiérrez Villegas, C., Paz-Zulueta, M., Herrero-Montes, M., Parás-Bravo, P. and Madrazo Pérez, M. (2021). Cost Analysis of Chronic Obstructive Pulmonary Disease (COPD): A Systematic Review. Health Economics Review. 11(31). 1-12.
19. Hacker, K. (2024). The Burden of Chronic Disease. Mayo Clinic Proceedings: Innovations, Quality & Outcomes. 8(1). 112-119.
20. Husaini, B. A., Taira, D., Norris, K., Adhish, S. V., Moonis, M. and Levine, R. (2018). Depression Effects on Hospital Cost of Heart Failure Patients in California: an Analysis by Ethnicity and Gender. Indian Journal of Community Medicine. 43(1). 49-52.
21. Iheanacho, I., Zhang, S., King, D., Rizzo, M. and Ismaila, A. S. (2020). Economic Burden of Chronic Obstructive Pulmonary Disease (COPD): A Systematic Literature Review. International Journal of Chronic Obstructive Pulmonary Disease. 15. 439-460.
22. Janssen, L. M. M., Hiligsmann, M., Elissen, A. M. J., Joore, M. A., Schaper, N. C., Bosma, J. H. A., ... and Evers, S. M. A. A. (2020). Burden of Disease of Type 2 Diabetes Mellitus: Cost of Illness and Quality of Life Estimated Using the Maastricht Study. Diabetic Medicine. 37(10). 1759-1765.
23. Keehan, S. P., Fiore, J. A., Poisal, J. A., Cuckler, G. A., Sisko, A. M., Smith, S. D., ... and Rennie, K. E. (2023). National Health Expenditure Projections, 2022–31: Growth to Stabilize Once the Covid-19 Public Health Emergency Ends: National Health Expenditure Projections for 2022–31. Health Affairs. 42(7). 886-898.
24. Kingston, A., Robinson, L., Booth, H., Knapp, M. and Jagger, C.(2018). Projections of Multi- Morbidity in the Older Population in England to 2035: Estimates from the Population Ageing and Care Simulation (PACSim) Model. Age Ageing. 47(3). 374-380.
25. Kirkland, E. B., Heincelman, M., Bishu, K. G., Schumann, S. O., Schreiner, A., Axon, R. N., ... and Moran, W. P. (2018). Trends in Healthcare Expenditures Among US Adults with Hypertension: National Estimates, 2003–2014. Journal of the American Heart Association. 7(11). e008731.
26. Lebina, L., Kawonga, M., Oni, T., Kim, H. Y. ve Alaba, O. A. (2020). The Cost and Cost Implications of Implementing the Integrated Chronic Disease Management Model in South Africa. Plos One. 15(6). e0235429.
27. Lopreite, M. ve Mauro, M. (2017). The Effects of Population Ageing on Health Care Expenditure: A Bayesian VAR Analysis Using Data from Italy. Health Policy. 121(6). 663-674.
28. MacNeil-Vroomen, J. L., Thompson, M., Leo-Summers, L., Marottoli, R. A., Tai-Seale, M. and Allore, H. G. (2020). Health-Care Use and Cost for Multimorbid Persons with Dementia in the National Health and Aging Trends Study. Alzheimer’s and Dementia. 16(9). 1224-1233.
29. May, S. M., and Li, J. T. (2015, January). Burden of Chronic Obstructive Pulmonary Disease: Healthcare Costs and Beyond. In Allergy and Asthma Proceedings. 36(1). 4-10.
30. McPhail, S. M. (2016). Multimorbidity in Chronic Disease: Impact on Health Care Resources and Costs. Risk Management and Healthcare Policy. 9. 143-156.
31. Meng, Z., Hui, W., Cai, Y., Liu, J. and Wu, H. (2020). The Effects of DRGs-Based Payment Compared with Cost-Based Payment on Inpatient Healthcare Utilization: A Systematic Review and Meta-Analysis. Health Policy. 124(4). 359-367.
32. Miethke-Morais, A., Cassenote, A., Piva, H., Tokunaga, E., Cobello, V., Gonçalves, F. A. R., ... and Haddad, L. (2021). Covid-19-Related Hospital Cost-Outcome Analysis: The Impact of Clinical and Demographic Factors. Brazilian Journal of Infectious Diseases. 25(4). 1-9.
33. Mohan, G. and Gaskin, D. J. (2024). Social Determinants of Health and US Health Care Expenditures by Insurer. JAMA Network Open. 7(10). e2440467-e2440467.
34. Mossialos, E., Wenzl, M., Osborn, R. and Sarnak, D. (2016). 2015 International Profiles of Health Care Systems. Canadian Agency for Drugs and Technologies in Health. Ottawa, Canada.
35. Mulpuru, S., McKay, J., Ronksley, P. E., Thavorn, K., Kobewka, D. M. and Forster, A. J. (2017). Factors Contributing to High-Cost Hospital Care for Patients with COPD. International Journal of Chronic Obstructive Pulmonary Disease. 12. 989-995.
36. OECD (2024). Health Spending. https://data.oecd.org/healthres/health-spending.htm. (Erişim: 02 Şubat 2024).
37. Ohsfeldt, R. L., Choong, C. K. C., Mc Collam, P. L., Abedtash, H., Kelton, K. A. and Burge, R. (2021). Inpatient Hospital Costs for Covid-19 Patients in the United States. Advances in Therapy. 38. 5557-5595.
38. Owens, G. (2008). Gender Differences in Health Care Expenditures, Resource Utilization and Quality of Care. Journal of Managed Care Pharmacy. 14(3). 2-6.
39. Poisal, J. A., Sisko, A. M., Cuckler, G. A., Smith, S. D., Keehan, S. P., Fiore, J. A., ... and Rennie, K. E. (2022). National Health Expenditure Projections, 2021-30: Growth to Moderate as Covid-19 Impacts Wane: Study Examines National Health Expenditure Projections, 2021-30 and the Impact of Declining Federal Supplemental Spending Related to the Covid-19 Pandemic. Health Affairs. 41(4). 474-486.
40. Rosella, L. C., Fitzpatrick, T., Wodchis, W. P., Calzavara, A., Manson, H. and Goel, V. (2014). High-Cost Health Care Users in Ontario, Canada: Demographic, Socio-Economic and Health Status Characteristics. BMC Health Services Research. 14(532). 1-13.
41. Seuring, T., Archangelidi, O. and Suhrcke, M. (2015). The Economic Costs of Type 2 Diabetes: A Global Systematic Review. Pharmacoeconomics. 33. 811-831.
42. Siddique, S. M., Tipton, K., Leas, B., Greysen, S. R., Mull, N. K., Lane-Fall, M., ... and Tsou, A. Y. (2021). Interventions to Reduce Hospital Length of Stay in High-Risk Populations: A Systematic Review. JAMA Network Open. 4(9). e2125846-e2125846.
43. Simon, J., Wienand, D., Park, A. L., Wippel, C., Mayer, S., Heilig, D. ... and McDaid, D. (2023). Excess Resource Use and Costs of Physical Comorbidities in Individuals with Mental Health Disorders: A Systematic Literature Review and Meta-Analysis. European Neuropsychopharmacology. 66. 14-27.
44. Soley-Bori, M., Ashworth, M., Bisquera, A., Dodhia, H., Lynch, R., Wang, Y. and Fox-Rushby, J. (2021). Impact of Multimorbidity on Healthcare Costs and Utilisation: A Systematic Review of the UK Literature. British Journal of General Practice. 71(702). e39-e46.
45. Solida, A., Noerjoedianto, D., Mekarisce, A. A. and Subandi, A. (2022). Costs and Impacts of Utilizing National Health Insurance Reducing the Economic Burden of Hypertension Patients. Jurnal Aisyah: Jurnal Ilmu Kesehatan. 8(1). 143-150.
46. Street, A., Maynou, L., Blodgett, J. M. and Conroy, S. (2025). Association between Hospital Frailty Risk Score and Length of Hospital Stay, Hospital Mortality and Hospital Costs for all Adults in England: A Nationally Representative, Retrospective, Observational Cohort Study. The Lancet Healthy Longevity. 6(8).
47. Su, F. Y., Fu, M. L., Zhao, Q. H., Huang, H. H., Luo, D. and Xiao, M. Z. (2021). Analysis of Hospitalization Costs Related to Fall Injuries in Elderly Patients. World Journal of Clinical Cases. 9(6). 1271-1283.
48. Su, M., Pan, D., Zhao, Y., Chen, C., Wang, X., Lu, W. ... and Liang, P. (2022). The Direct and Indirect Effects of Length of Hospital Stay on the Costs of Inpatients with Stroke in Ningxia, China, Between 2015 and 2020: A Retrospective Study Using Quantile Regression and Structural Equation Models. Frontiers in Public Health. 10. 881273.
49. Taheri, P. A., Butz, D. A. and Greenfield, L. J. (2000). Length of Stay Has Minimal Impact on the Cost of Hospital Admission. Journal of the American College of Surgeons. 191(2). 123-130.
50. Tran, P. B., Kazibwe, J., Nikolaidis, G. F., Linnosmaa, I., Rijken, M. and van Olmen, J. (2022). Costs of Multimorbidity: A Systematic Review and Meta-Analyses. BMC Medicine. 20(234). 1-15.
51. Trautmann, S., Rehm, J. and Wittchen, H. U. (2016). The Economic Costs of Mental Disorders: Do Our Societies React Appropriately to the Burden of Mental Disorders? EMBO Reports. 17(9). 1245-1249.
52. Wammes, J. J. G., van der Wees, P. J., Tanke, M. A., Westert, G. P. and Jeurissen, P. P. (2018). Systematic Review of High-Cost Patients’ Characteristics and Healthcare Utilisation. BMJ Open. 8(9). e023113.
53. WHO (2025). WHO Covid-19 Dashboard. https://data.who.int/dashboards/covid19/deaths (Erişim: 22 Nisan 2025).
54. Wierzejska, E., Giernaś, B., Lipiak, A., Karasiewicz, M., Cofta, M. and Staszewski, R. (2020). A Global Perspective on the Costs of Hypertension: A Systematic Review. Archives of Medical Science. 16(1). 1078-1091.
55. Zhao, Q., Coelho, M. S., Li, S., Saldiva, P. H., Abramson, M. J., Huxley, R. R. and Guo, Y. (2020). Trends in Hospital Admission Rates and Associated Direct Healthcare Costs in Brazil: A Nationwide Retrospective Study Between 2000 and 2015. The Innovation. 1(1). 1-15.