Study On Development Of The Physical Examination Package For Urban Employees

Physical examination is referred as a tool packages to detect the unobservable disease or the latent period of disease among the people who objectively have no symptom. The aims are to treat the detected diseases as soon as possible on the one hand, and to prevent illness on the other hand. It is an important health care management method to understand the nature of health in peoples' daily life and to pay attention to improve the healthy behavior. In addition, the improvement of health and health status are an important symbol to present social development and social civilization. The goal of physical examination is to find the potential disease earlier in order to treat and cure the disease as soon as possible; to screen various healthy indicators and then measure the change of various physical functions of a person; to intervene the life behavior to prevent the risk factors affecting health. The criterion and effective physical examination could achieve both social benefit and economic benefit. In other words, social benefit means the improvement of an individual's health and then lead to the improvement of population health. In addition, economic benefit represents the reduced health expenditures of an individual; the effective reallocation of hospital resource. These could lead to improve the demand for health and then promote the health care industries.At present, the international literature shows that the research of physical examination are focused on how to well manage the physical examination, and the use of physical examination database to establish health risk appraisal system to forecast disease or the risk of mortality. However, there is no detailed research on the physical examination package in China. Although the history of physical examination is just about 20 years, it has growing to a relatively large market for physical examination. So far, the current research for the physical examination is just to the analysis and evaluation of an individual's health status, or to the factor analysis such as prevalence and mobility rate. There is little research to systematically analyze the physical examination package. In addition, there are still some occurred problems as such the business plan and content of the package in the process of developing the physical examination industry. For example, the integration of physical examination into the boundary of hospital services was not permitted by health authorities. This leads to the objective of physical examination is not clear and then to relevant less managerial method; to nonindustrial standard in accordance with business module, location, equipment, physical examination items, and service level; to less service provided to the general population due to less service item provided and relative expensive prices. In particular, the "combination of physical examination items" provided by hospitals and/or institutions are for profit motivation. Furthermore, the items and service price were not designed in accordance the demand for physical examination and affordability. These are referred as lacking of restrict scientific evidence, of non considering of maximally detecting disease and positive rate, and of various service items to meet the different demand categorized by gender, income, and epidemiological pattern. Therefore, the selective suggestions be made, in accordance with WHO recommended physical examination items, to maximize the benefit of physical examination service providers and demander for the services. A combination theory from epidemiology, clinical medicine, and health economics, able to design various service package to meet different demand. The objective of the study is to design two physical examination item packages, by targeting the particular population, basing on the database obtained from urban employee physical examination results at a specialized hospital in Shandong province.The first package is to design a particularly required physical examination items in line with ICD-10. It is based on disease category, the probability distribution of the positive rate, and disease pattern of anthroponomy. In addition, it ensures the package in line with the disease category.The second is to design a basic physical examination item in line with ICD-10. The physical examination package, designed by income level and age, is based on disease category, the probability distribution of the positive rate, and the cluster analysis. It is stratified in accordance with disease category and positive rate identified. Firstly, the sample is categorized into both male and female sub-sample by gender. Secondly, the cluster analysis is undertaken in each male and female sub-sample. Finally, the disease category and positive rate are treated as the cluster factors to cluster the physical examination package among different age groups.The objective of designing the Physical examination packages are as follows; a) It should meet the need of an individual's choice in accordance with her/his gender, age, health status, economic condition. This may lead to reduce the asymmetric information and then to increase the transparency of choosing appropriate "combination of physical examination items" for each individual. Therefore, it may more or less reduce the phenomena of supply-induced demand. In general, it could save the limited resource and reduce the financial burden for individual; b) The purpose of designing the stratified Physical examination packages are to well understand the common base disease for both male and female, age-specified mobility, and so on. In other words, it is useful for researchers to analyze the chronic disease management and its effective interventions, epidemiological survey, and molecule genetics; c) The importance of designing reasonable physical examination package is to guide the collection of individuals' health information, risk evolution and forecast, health maintenance, and health promotion; d) It is also a value-added method to enrich and develop the theoretical research of physical examination industry. In conclusion, the general objective of the study is to criterion the physical examination market, improve the quality of physical examination service and its efficiency, ensure the reliable and testable results, improve the equity and transparency of the price of physical examination service. It is expected that the results obtained from the study could be recommended to policy makers for making appropriate policy and documents.Results:1,The specified physical examination package by the disease pattern of anthroponomy It is designed by ICD-10. Nine specified physical examination packages, including Respiratory System,Circulatory System,Alimentary System (Liver,Gallbladder,Pancreas,spleen service package and stomach,intestine service package),urinary system,hematological system,Endocrine and metabolic system,nervous and skeletal system,gynecologic and anthology exam service package, are designed in accordance with disease category, the probability distribution of positive rate, and the disease pattern of anthroponomy. The price of medical examination projects is in strict accordance with the standards of uniform pricing regulated by Shandong bureau of price.2,The basic physical examination package in terms of gender, age, and disease patternIt is designed in accordance with ICD-10. Ten basic physical examination packages are designed, stratified by gender and age group, basing on disease category, probability distribution of positive rate, and the cluster analysis.a) Four packages are designed with specification for male. They are 40 years old below, 40-49 age group, 50-59 age group, and 60 years old and above respectively.b) Six packages are designed for female including 30 years old below, 30-39, 40-49,50-54,55-64, and 65 years old and above age group respectively.In terms of age group in each physical examination package, it is ranked as A, B, and C according to the probability of disease category and positive rate identified in the target population. Hence, Package A represents the basic physical examination package. The combination of choosing package A, B, and C are decided by the needs for physical examination or each individual financial affordability. However, the repeated items in the package are not double charged if they are overlapped among different packages.Conclusions:1. Nine specified physical examination packages are designed, in accordance with ICD-10, to satisfy the various demand for physical examination. The packages are scientifically designed basing on disease category, the probability distribution ofpositive rate identified, and the disease pattern of anthroponomy.2. Basing on disease category, the probability distribution of the positive rate identified, and systematic cluster analysis, the packages are designed in line with ICD-10. In addition, it is further stratified in terms of gender and age group to increase the flexible operation.3. The applicability and penalization of the urban residents' physical examination packages are reasonable. It not only gives attention to the benefit of the providers, but represents the benefit of demand side for the physical examination services.4. It provides a theoretical method and idea for each target population of the physical examination items through studying the urban residents' physical examination packages.Recommendations:1. The health authorities should pay attention to the research of physical examination. Basing on the research results, it could rationally regulate the physical examination market.2. The physical examination service providers should evaluate and summary the effectiveness of using the different packages. This is required the providers choosing appropriate packages in terms of effectiveness, cost and efficiency of the physical examination service. Thus, the quality of service could be improved.3. The service provider should pay attention to collect information of each physical examination. This further helps to trim and analysis the results.4. In addition, to criterion the Physical examination packages, it is required the emphasis of educating the importance of Physical examination, the increasing financial inputs from the government, the improvement of utilization rate of the Physical examination services. Then, these measures could exert the objective of servicing the general population for the service providers.5. The further study should pay attention to evaluate the benefit of each physical examination package and undertake the willingness to pay analysis.