To optimize medical cost control, enhance disease prevention systems, and reform healthcare payment models to investigate hospital care status, cost components, and influence factors for ischemic stroke patients in Changzhi, Shanxi.

Based on the hospitalization data of 90 465 patients with ischemic stroke in Changzhi from 2018 to 2023, a structural equation model was constructed to analyze the factors affecting hospitalization costs.

Ischemic stroke hospitalizations increase annually (males faster), with the 60-69 age group being predominant and onset age shifting older. The average length of stay is 11.58 days (decreasing), and the proportion of critical/urgent admissions rises, indicating increased disease severity. More patients undergo clinical pathways, with more cured/improved cases (suggesting medical advances). Patients with ≥2 admissions and those visiting tertiary hospitals are increasingyearly. The average hospitalization cost is 8 965.01, dominated by drug and diagnostic fees; while average cost, comprehensive service, treatment, and rehabilitation fees rise, diagnostic and drug costs decline. SEM analysis ranks influencing factors as: length of stay>hospital level>age>gender>number of admissions>clinical pathway implementation>condition at admission>medical insurance type.

Although initial progress in cost control is seen, patients’ economic burden remains heavy. It is necessary to optimize cost structure and hospitalization cycle management, focus on influencing factors, and strengthen whole-cycle disease prevention and control.