5.1 HIV/AIDS patients are mainly male, middle-aged and elderly group
As HIV treatment approaches improve, new challenges and opportunities emerge. On the one hand, for people receiving ART, AIDS becomes a chronic disease with an increased risk of chronic comorbidity, including cardiovascular disease [7], depression [8], diabetes [9] and cancer [10], which also greatly increases the cost of treatment [11] for HIV/AIDS patients. For older HIV/AIDS patients, they are at greater risk of geriatric comorbidities and aging related problems. Verheij E et al [10] in a prospective cohort of 596 HIV-positive and 550 HIV-negative participants, found that the incidence of chronic diseases in HIV-positive patients increased with patient age and was associated with increased risk of death, particularly malignancies. The results of this study found that, the hospitalized patients were mainly middle-aged and elderly patients, that is, mainly to the young elderly, age factors have not had a significant impact on hospitalization costs, this window period should be captured, strengthen the importance of the elderly to the use of medication, improve medication adherence among the elderly, to slow down the continued aggravation and deterioration of the disease, reduce treatment costs; on the other hand, over the past 35 years, Significant changes in the route of HIV infection in our country, From an initial epidemic occurring only among injection drug users, By the mid-1990s outbreak due to contamination with plasma collection, and then now is spread almost exclusively through sexual contact, in the route of sexual transmission, HIV transmission by men who have sex with men (MSM) showed a clear upward trend [12]. Since 1997 criminal law changes, male behavior in our country has legal [13], but our country's traditional social culture, lead to this group often face shame and discrimination, make them hide their sexual behavior, partners and medical workers and, the lack of sex education, factors lead to the increase of same-sex transmission route of [14]. Wang Qiuli and et al. [15] analyzed the number of HIV/AIDS patients in Tianqiao District of Jinan from 2004 to 2021 and found that the proportion of HIV through sexual transmission had reached 99.4%, and the number of male reported cases increased rapidly, with same-sex transmission accounting for 88.2% and heterosexual transmission accounting for 11.8%. More male inpatients than female patients may also be related to the growth of same-sex transmission patterns, and such sexual transmission must be valued.
5.2 Analysis of the factors influencing the hospitalization costs in patients with AIDS
In the present study, In the details of the hospitalization expenses, drug, laboratory test and physiotherapy costs are the main components of hospitalization costs, nursing cost and bed fee are the two most highly associated factors among the hospitalization costs, other items all have a high correlation degree, as can be seen, with the implementation of medical reform policies such as "canceling drug markup" and "centralized collection of consumables", the correlation between drug costs and hospitalization costs varies very little from the costs of other items, but drug costs are still the main cost of hospitalization, the proportion of laboratory test fee and physiotherapy fee is outstanding; from the perspective of the patient factors, LOS is a key factor affecting hospitalization costs, this is consistent with other studies [16]. Therefore, if you want to reduce your hospitalization costs, one is to start from the cost structure, for the management of drug, laboratory test and physiotherapy fees, strengthen the monitoring of the costs of drugs and consumables, after eliminating the drug addition, hospital profits are cut ashed, you may even make ends meet [17], then then the phenomenon of excessive testing, excessive examination, while strengthening supervision at the hospital level, add pharmaceutical service fees, adjust medical service fees and special subsidies for hospitals, reasonable subsidies to hospitals, not only can avoid "prescription drugs, drug drugs, waste drugs", and also to ensure the normal operation of public hospitals, finally achieve the goal of reducing the proportion of costs of drugs and consumables. Second, to shorten the length of hospital stay, at the hospital level, from the actual needs of the patients, optimize the hospitalization process; strengthening the clinical pathway management, to maximize medical resource utilization and quality of care, shorten the treatment days [18], improve the quality control of medical and treatment services, increase in the hospital bed turnover rate, reasonable control of LOS.
5.3 Hospital cost analysis of HIV/AIDS patients with different insured types
According to the results of this study, the presence of medical insurance and the type of insurance have a great impact on the proportion of patients' personal self-paying expenses, especially in the proportion of personal self-paying expenses in the total hospitalization expenses. Patients with medical insurance are divided into one to three grades, and the proportion of individual out-of-pocket payment is 15.48%, 19.31% and 30.45%, respectively. Relatively speaking, for a group of health insurance participants, the direct economic burden is the smallest, while patients without any medical insurance have the greatest direct economic burden. At the end of 2003, China issued the national policy of "four exemptions and one care", which increased the coverage of ART and HIV testing, and also greatly reduced the cost of treatment for HIV/AIDS patients. Although the government provides free testing and ART to patients, it does not include the cost of other necessary procedures, such as diagnostic and laboratory test and drugs for treating opportunistic infections, and therefore, the amount actually paid by patients is still quite high. At the same time, in terms of commercial insurance, AIDS has been various insurance companies, in 2009, China insurance industry association issued the personal insurance product clause part article model writing, this situation to get the transformation [19], but the commercial insurance awareness of AIDS has not changed, the current HIV/AIDS patients for commercial insurance coverage is still very difficult. Withal, this gap can be narrowed in the following ways, one is to develop health insurance policies more consistent for AIDS patients, to appropriately expand the coverage and proportion of medical insurance, meeting the medical needs of the vast majority of HIV/AIDS patients, increase the attention to HIV/AIDS uninsured patients, guide patients to try to buy medical insurance and serious disease medical insurance, to ensure the medical services for patients, address the financial burden of spending more on hospital costs; second, to guide all sectors of society to treat HIV/AIDS patients equally, because of the stigma nature of AIDS, culture, legal, and AIDS-related policies play a crucial role in preventing the spread of AIDS, increase the popularization of AIDS science, develop relevant policies, raise the correct awareness of AIDS, create a non-discriminatory social environment, to protect the legitimate rights and interests of HIV/AIDS patients, so that patients can equally enjoy the basic medical security services; third, insurance companies should further improve the compensation system in AIDS commercial insurance, guarantee the guarantee level of medical and commercial insurance for HIV/AIDS patients.