Objectives: To describe the disease structure according to ICD-10, health insurance medical examination and treatment costs, and some factors related to total expenditure.
Methods: The retrospective descriptive study using big data from the health insurance payment database at Moc Chau regional General Hospital for the years 2023-2025. Data were extracted from the health insurance system records and analyzed using SPSS 26.0 software. Indicators are described by frequency, percentage, mean, standard deviation, and median. Multivariate regression was used to analyze the relationship between total expenditure and age and number of comorbidities.
Results: The total number of cases increased gradually over the years from 58,519 in 2023 to 62,357 in 2024 and 64,737 in 2025. Endocrine, nutritional, and metabolic diseases accounted for the highest proportion and increased significantly from 20.3% in 2023 to 27.5% in 2025. Circulatory system diseases ranked second, fluctuating from 14.5% to 15.9%. The average cost per patient for the 10 most common diseases increased from VND 2,497,637 in 2023 to VND 3,291,402 in 2025. The cost of treatment for diseases outside the top 10 most common illnesses increased from 3,067,453 VND to 3,674,413 VND. The average cost of an inpatient treatment covered by the health insurance fund accounting for approximately 83.52%-86.77% of the total cost; patient co-payments ranged from 13.23-16.48%. The proportion of ethnic minority patients paying low fees decreased from 1.00% in 2023 to 0.59% in 2025. Multivariate regression showed that age and the number of comorbidities were statistically significantly related to total inpatient and outpatient expenses over the years (p < 0.001).
Conclusion: The disease structure of health insurance patients at Moc Chau regional General Hospital during the 2023-2025 period mainly focuses on non-communicable diseases, especially endocrine, metabolic, and circulatory diseases. Medical examination and treatment costs tend to increase, with the health insurance fund remaining the primary source of payment. Age and the number of comorbidities are factors related to total expenses.