| ObjectiveThe medical expense control is a common question which many countries face because of the economic interest mechanism.The way of price rules and regulations to medical service decided the size of intensity when medical organizations provide each kind of medical service, this adjust is being standard their behavior, and decides the medical expense finally. Therefore, to use suitable way of rules and regulations is very important to the control of medical expense. Therefore, the reform of medical expense payment way and the research are one of attention subject matters. Since 2000, some hospitals in China's cities started reform of payment system of disease type, which played a certain role of the rising expenses containment of hospital care, but the result was not ideal, is still faced the challenge from lots of problems. How many factors impact the medical expense and the medical expense containment of single disease? How many factors of management impact the effects of the implementation of single disease expenses control? How to establish and implement a suitable management strategy of inpatient medical expenses containment for China's national conditions? Documentation shows that the study of these issues are still not systematic and comprehensive, especially the study on management and control system for hospitalization expenses containment has not yet been reported.Using qualitative and quantitative methods,the study combined with the theoretical analysis of the hospitalization expense containment, as well as the reasons, the research on the status research and the key elements of the increasing of hospitalization expenses, and the theory review of hospital care expenses containment, drawled on experiences on medical expenses containment at home and abroad , studied the strategy of management and containment by analyzing medical cost accounting and factors affecting the expenses. Based on management control theory, the study proposed the framework of management and control system for the current China-inpatient. Through analyzing typical cases in sampled hospitals, this study empirical research the application effect of management and control system to provide the basis for forming an effective incentive and restrictive mechanisms and playing the real role of disease expenses containment in the disease medical expenses containment.Methods1.Literature research methodsUsing non-structural,non-quantitative methods to access the professional magazine,journals, essays and on-line retrieval text, graphics, sound and other relevant literature, collecting data concerning expenses containment in the process of hospital medical services at home and abroad,collating and analysising related systems about medical expenses containment, specific programmers and statistics data from sample hospitals and relevant government departments.Then all kinds of documents and information were summarized and concluded objectively and systematically.2.Secondary data collection and analysisIn two sampled hospitals,retrospective survey from 1,341 patients four disease types of include the demographic characteristics of patients, hospital expenses and the total expenses of the project specific indicators. the hospital's actual hospital beds, number of hospital revenue and expenditure expenses of the project in sampled hospitals; collecting related indicators of hospitals expenses control after inpatient hospital medical expenses management control system was used in sampled hospitals;at the same time,in a two-level hospitals in Hubei Province, collect and analysis data in 2006 on the hospital beds, hospital revenue and hospital expenses and the expenses of the project of a single-species disease calculation of the expenses; in a three-level hospital in Shandong Province, investigate related indicators of hospitalization expenses containment after management and control of hospitalization expenses control system was used from 2004 to 2007.3. Semi-structured depth interviewsOn the basis of the first part information and the results of intelligence analysis, visit and ask 36 persons ,including the health sectors, health management experts, hospital management from medical institutions and medical professionals (12-16 persons),who are randomly sampled from every hospital-located areas.Ask those persons pre-determined questions on the hospital medical expenses containment and the key links in the main influencing factors in semi-structured interviews and analysis those information, acquire and tap the in-depth information and data.4. Panel discussionsInvited 46 persons from three sample areas(about 14-16 persons from each sample area),including experts in health economy and health management areas,managers from health administration departments,the hospital management staff from medical institutions and medical professionals,to discuss problems on the factors of the hospital medical service cost, the factors of the hospitalization expenses containment, the strategy of hospital care cost control and control and management system.The factors impacting the cost management of hospital care and the management strategy were excavated in breadth and depth.5. Survey methodThrough literature search and interviews with relevant staff, the study summarized related system of expenses containment and the major contents. According to the above results, the papers developed questionnaire of expenses containment system, randomly selected 96 people from medical insurance institutions, health administrative departments, hospital administrators and medical staff in three sampled areas, surveyed more than 30 people in each region by the questionnaire on importance of the system.6. Expert advice methodUsing Delphi expert advice method, the study demonstrated evaluation indexes of disease standard expenses in three rounds of expert advice, determined and studied the evaluation indexes of hospital cost containment, and established the evaluation index system of hospital cost containment.7. Statistical methodsSingle factor analysis: Using T-test and variance analysis to analysis data in normal distribution for comparative analysis; using rank sum test to analysis data in non-normal distribution.Multivariate analysis methods: Using multiple linear regression analysis to screen the key factors impacting the hospitalization containment.Results1. Analysis on the medical expenses containment and discriminate the situation Using literature studying, panel discussions and other methods, the study analyzed the reasons for the rising medical costs and cost control issues,and considered that the reasons for the increase of the health care expenses can be divided into two categories: One is that the growing population ,changes of the ageing of the national population and the disease structure, as well as the application of new medical technologies resulted in reasonable growth of medical services being followed by the growth of medical expenses, and the other is the deficiencies of medical insurance system, the defects of organizational structure and mechanism of medical services and non-rational behavior of medical expenses and other non-rational factors, the latter can be controlled by improving supply system and service standards as well as guiding reasonable behavior.The situation of medical expense control is unoptimistic in our country ,Over several years, average growth rate of China's health total expenses was significantly higher than the annual average growth rate of GDP, if medical expenses are not reasonable controlled, in the next 40 years China's health care expenditure will increase relatively.2. The characteristics and influence factors of medical expenses containment Analyzing the characteristics of medical expenses containment and the difference analysis of medical expenses containment from different payment system of medical expenses, , the study pointed out the main reason for difficulty of medical expenses containment were decided by the special nature of medical services market and the payment system of medical expenses. The most direct way impact the expenses and cost of medical service providers is changing the payment system.After compared several payment systems, the study pointed out that implementing expenses containment of single disease will be a trend of Chinese medical expenses containment strategy in the future.Using non-wilcoxon test and t-test ,the papers analyzed difference of the expenses between the diseases of 1,354 patients. At the same time,Using multiple linear regression analysis to screen the factors of the hospitalization expenses, the study found that hospitalization expenses were related to hospitalized days, indicating that we must firstly control the hospitalization time to control the hospitalization expenses.Besides,the study described there exist differences among demographic characteristics impacting different kinds of diseases expenses, Hospitalization expenditure of Appendicitis and Adult Pneumonia cases is related to the case type and the patient's age, so it's necessary that case type and the patient's age should be considered to develop the standards of expenses containment. On the contrary, Children Pneumonia and Caesarean cases is not related to the case type and the patient's age, so it's not required to consider case type and the patient's age to develop the standards of expenses containment.3. Research on hospitalization cost budgetUsing literature studying,the study summarized the relevant systems of expenses containment,and analyzed the basic framework of the budget control system.After analyzed the suggestion from economic management experts, hospital managers and medical personnel, and other relevant staff by semi-structured interview, questionnaire survey and symposia,the study developed the table for cost estimates of single disease(see Annex).After determined the apportionment way and the clinical path of diseases,we can carry out cost accounting work of specific kinds of diseases. Firstly, we should develop the clinical pathway of calculated disease,and determine the days of stay.Then, It's necessary to separate the expenses, distinguish between direct expenses and indirect expenses,and carry out cost estimates of single disease based on the clinical path.The papers identified that the main factor impacting indirect cost is the days of stay,pointed out the basic steps and methods for estimating cost of hospitalization disease care, studied the basic ideas of the disease cost calculation, choices of disease types and calculation methods.Using analysis methods of typical case,the papers analyzed the basic ideas and methods of the standard cost expenses calculations for the simple Caesarean section patients from a two-level hospitals in Shenzhen.4. Study on evaluation of hospitalization expenses containmentThe study researched the evaluation criteria of the disease standard cost, gave the evaluation index of hospital cost control by using the Delphi expert advice method,and weigh the indexes ,established the evaluation index system of hospital cost control. The evaluation indicators of single diseases'expenses containment were determined as follows: three One-level indexes including average hospitalization expenses index, expenses structure index and efficiency index and average bed fees, the average drugs'expenses, the average inspection fees, the average expenses of treatment, the average surgery fees, the proportions of drugs'expenses in total expenses, the proportion of inspection fees in the total expenses, average hospital days, treatment efficiency and patient's satisfaction diseases such as ten Two-level indexes. At the same time, the weight of the index system and the application of the index system were analyzed by the case study.5. Construct management and control system of hospitalization expenses containment With the theory of management control and the analysis of the characteristics of medical expenses containment,the study pointed out that in the fee payment system of single disease, it's necessary to establish effective medical expenses containment management strategy, which will contain the personal behavior of clinical departments and medical staff being not attach the expenses containment to ensure the consistency of objectives and behavior of the staff and that of the whole hospital,and form a long-term mechanism for medical expenses containment.Making researches on the main part of cost control and critical factors of expenses containment in the hospital implementing disease prepaid system, the papers summed up eight main factors impacting medical expenses containment.these include:changes in the concept of the hospitals'leaders,changes in the mode of medical insurance payments and the pressure on the medical market,the improvement of management system and the instauration of allied agencies,system building for medical quality, the standards for estimating expenses scientifically and controlling expenses reasonably,the dynamic machanism of quality supervision, the mechanism of scientific evaluation and effective incentive ,and the risk of moral hazard from both the patient and the doctor.Learn from the management and control system theory for enterprises and combine the changes of the medical market and the analysis of hospital expenses control environment, as well as the research on hospitalization strategy,the study proposed the theoretical framework of the control and management control system for the hospitalization expenses control,which suit to China's single disease management. The framework includes the system control system, and budget control system, evaluation control system and framework of incentive control system.6. Empirical study on the control system of hospitalization expensesInvestigating and analyzing the specific process of implementing control system for hospitalization expenses and the effects of disease expenses control in a three-level hospital in the Jining city of Shandong province,the papers found that implementing single-disease expenses control produced the obvious social and economic benefits. Single disease hospitalization expenses decreased significantly, and the total number of hospital patients increased, and patient satisfaction and the overall performance of the hospital were improved significantly.Conclusions1) Medical expenses containment is still a worldwide difficult problem so far, the main reason for difficulty of medical expenses control is decided by the special nature of medical services market and the payment system of medical expenses. Using interest mechanism, the expenses containment of single disease can attain the purpose that not only to control health care expenses, but ensure the quality of medical services. implementing expenses containment of single disease will be a trend of China's medical expenses containment strategy in the future.we should actively explore ant implement the control strategy for hospitalization expenses of single disease.2) There exist differences among disease characteristics and demographic characteristics impacting different kinds of diseases expenses,so it's necessary to analysis the relevant factors of common disease expenses in hospitals, prepare evaluation criteria of different payment systems and expenses control to provide more scientific basis for medical insurance institutions,health administrative departments.3)In order to play truly the role of the disease expenses control, according to the management and control system for hospitalization expenses control in this papers, different hospitals should integrate their hospital practice to establish a scientific and reasonable management and control system for hospitalization expenses control and form the incentive and restraint mechanisms for hospitalization expenses control. 4) In the circumstance of lower flexible of demand for quality medical services, the hospitals have inadequate incentive to improve service quality , in order to lower cost, they reduce essential services possibly, such as insufficient treatment or require patients to premature discharge and so on.5) In order to control increased expenses caused by the risk of moral hazard,we should establish strict regulation and system of the medical service quality, strengthen the administration of medical services and the legal system, improve guarantee system of the medical service quality. At the same time,it's necessary to strengthen professional ethics education and the self-discipline of medical behavior. Besides,we should use the expenses-sharing mechanisms to reduce the risk of moral hazard from the excessive medical spending behavior, to control the unreasonable increased expenses.
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