| [Background]1, Management of major medical equipment is facing new challenges under the background of health care system reform. The "Opinions of deepening the health care system reform by the central committee of the communist party of China and the state council" proposed that the aim of this reform is to build a health care system with Chinese characteristic and gradually achieve the goal of everyone having access to basic medical and health services. Health technology is the material core of the health care system, and major medical equipment is a significant part of health technology. With the rapid development of modern medical science and technology, major medical equipment are widely equipped and used in China, among which the computed tomography (CT) and magnetic resonance imaging (MRI) were introduced into medical market in China for many years and got a wide range of application, thus they became the representative of major medical equipment. The utilization of major medical equipment has duality meanings. On the one hand, it enhances the ability of disease diagnosis and prevention. On the other hand, it also brings some negative influences and consequences. There are some unique characteristics of major medical equipment that the treatment principle is new, images are clearer and easier to read, and capital investments, operation cost and scanning cost are high. Under the current hospital management system, there might be some economic stimulus during the utilization of CT and MRI, which is closely related with the current tense doctor-patient contradiction and problem of "difficulty and expense of medical service ". Therefore, it is an important strategic problem of how to manage major medical equipment scientifically, reasonably and effectively in the background of health reform.2, The number of distribution and utilization of major medical equipment studies is obviously insufficient, and the status of distribution and utilization of major medical equipment in China needs to be assessed. Medical and health resources are scarce resources, and various studies of health care resources increased gradually because the governments continued to strengthen the attention on it. In China, to develop research on major medical equipment management is keen on easing the current tense physician-patient relationship and promoting the smooth implementation of the new health care reform because there are some unreasonable purchase and use of major medical equipment. But there are only a few researches about the distribution or utilization of major medical equipment in the literature, among which the research period and places were not consistent.3, The research perspective and study depth of major medical equipment need further development to better serve the health care reform. There are a small number of targeted published studies in academic journals. Among them, the research methods were simplex, the considerations were not comprehensive, and few study were horizontal data analysis with a certain time span or with compared longitudinal study nationally. At the same time, most of the researches had no in-depth data statistical analysis, so no evidence-based conclusions could be drown. This study helps to expand the view of major medical equipment distribution and utilization research, to promote the theory development of equity in distribution, use efficiency and appropriateness of major medical equipment, to enrich and update the quantitative research literature information of distribution and utilization of major medical equipment, and to better serve the health policy and decision making.[Objectives]To systematically analyze the equity status of distribution, efficiency and appropriateness of utilization of CT and MRI in China with health resource allocation and utilization evaluation methods, and provide evidences for health care decision-makers in the management of major medical equipment.Specifically, this study is based on the research methods of health resource allocation and utilization both at home and abroad, combined with the special situation in our country, to integrate the distribution and utility method of CT and MRI. This study chose some sample areas to describe and evaluate the status quo of distribution equity, utilization efficiency and appropriateness of CT and MRI, to analyze the influence factors, and to put forward the corresponding policy recommendations of major medical equipment management with comprehensive data analysis. [Methodology]1, Theoretical basis and research methods of distribution and utilization of CT and MRI. This part of research defined the basic concepts and theory related to CT and MRI management, analyzed and summarized the methodology of distribution and utilization of major medical equipment, selected appropriate method for this study through comprehensive search and review of literature, and at the same time, introduced sampling methods and sample selection.2, Background and environmental analysis of CT and MRI distribution and utilization. Data of this part was derived from the health administrative departments at all levels of government official website and various statistical yearbooks. The nature, demographic characteristics, health resource allocation level and related policies and their implementation of the sample provinces were described and analyzed.3, Research of equity of CT and MRI distribution. Data of this part mainly came from the research questionnaire and the health statistics yearbook of the samples. Year2006and2009were selected as the research points, and there were three levels of samples. For the first level, Zhejiang, Hunan and Shaanxi provinces and Shanghai were selected in China’s eastern, central and western part as a reflection of social and economic development difference between different parts of the samples. For the second level, the capital city of each province and a randomly selected city of each of the sample province were selected. There were seven cities including Shanghai in this level. On the third level,25%of all the secondary hospitals and tertiary hospitals of each sample cities were selected as sample hospitals. Data of two aspects were collected in each of the sample hospital:one is questionnaire survey of the four sample provinces, and the data included geography, demography, economics and CT and MRI number in each of the cities; the other one is detailed information about CT and MRI features within the sample hospitals through questionnaire survey and qualitative interview, including equipment type, manufacturer, price, government subsidy, etc. At the same time, we collected CT and MRI distribution number in some world organization for economic cooperation and development (OECD) countries in2006and2009on their official website to do data analysis compare to data in domestic sample points.Methods of equity research in the field of health economics were used to analyze and discuss the equity in CT and MRI distribution and the related factors, such as equipment types, sources of funds, government subsidies, etc. Specific research methods included Lorentz curve method, the Gini coefficient method, method of correlation analysis, single factor influence factor analysis, multiple factors influence factors analysis, qualitative interviews, etc.4, Utilization efficiency of CT and MRI. Data of this part mainly came from the questionnaire survey research, qualitative interviews and health statistics yearbook of survey samples. Sample selection was based on the equity distribution analysis part, and typical agency survey samples were added. In particular, we added one grade A tertiary hospital, one grade B tertiary hospital, one grade A secondary hospital, and one grade B secondary hospital as sample hospitals in each of the seven sample cities. Through questionnaire survey, we got data of hospitals, operators, etc. Through qualitative interviews during the typical investigation, we got qualitative data of CT and MRI utilization status and related factors.Methods of effectiveness research in the field of health economics were used to analyze the status quo and influence factors of the utilization effectiveness of CT and MRI from the perspectives of province, hospital and equipment operator. We chose number of examination per year and capacity utilization as the indicators of utilization effectiveness. Specific research methods included key insider interview, method of correlation analysis, t-test, chi-square test and Logistic regression.5, Appropriateness of CT and MRI utilization. Data of this part mainly came from the research of qualitative interviews and questionnaire survey. Shanghai and Nantong city in Jiangsu province were chosen as samples to be on behalf of the appropriateness level of CT and MRI utilization in the relatively higher economic development level areas in China. In the sample regions, we chose two tertiary hospitals and two secondary hospitals to do typical sampling survey. Determined by clinical expert consulting method, we chose clinical records of the main diagnosis of pneumonia, lung cancer and brain malignant tumor to do sampling investigation. Through systematic sampling method, a total of480copies in year2011of clinical records including160copies of each disease were chosen in the four sample hospitals. Each medical record was copied three times and the three copies were sent to three evaluation experts separately, and the experts independently evaluated the appropriateness of utilization according to the questionnaire in the copy back to back. We invited13evaluation experts, all of whom were chief physicians of grade A tertiary hospitals majoring in radiology, respiratory, thoracic surgery or neurosurgery. More than half of the experts were retired or in the phase of restart, this can guarantee the quality of medical record review. Expert judging results were sorted and analyzed statistically and the possible influencing factors were found and analyzed. Specific research methods included expert interview, correlation analysis, t-test, chi-square test and Logistic regression analysis, etc.6, Research conclusions and suggestions. We combined the research results with the requirements of management of major medical equipment in the new round of health care reform and put forward policy recommendations for the optimize management of CT and MRI distribution and utilization.[Results]1, This research analyzed in detail the management and policy environment of CT and MRI in the present stage in China. After reading the policies and regulations on the utilization and management of major medical equipment of all levels of government, we found out that the major medical equipment management system was gradually developed and perfected, which promoted the reasonable distribution and effective utilization of major medical equipment. It is beneficial for the improvement of distribution equity of health resources if the government kept in charge of major medical equipment management.At present stage, it is the government that controls the distribution number of major medical equipment. Since there are huge difference in different regions in terms of population, geography, economy and culture, whether it is suitable to put the authority of CT and MRI to the provincial health administrative departments’, to form different layers of management and achieve higher management efficiency remains is to be further discussed.Factors such as equipment characteristics, government subsidies, regional economic development level were integrated to describe the present situation of the equity allocation in CT and MRI. We found that in2009, the distribution number level of CT and MRI according to the proportion of the population in our country was lower than most of the selected OECD countries, while from2006to2009, the growth rate of CT and MRI distribution quantity per million population was much higher than the vast majority of the selected OECD countries.Although the overall level of CT and MRI distribution was low, the equipment configuration of equity was not. In2006and in2009, the equity of CT distribution were both in the low level of inequity. At the same time, the equity of MRI distribution enhanced from high level of unfairness in2006to moderate level of unfairness in2009.The extent of CT and MRI distribution increase were different among different regions. Among all the sample provinces, the enhancement of CT in Shaanxi and MRI in Hunan were highest. Since both Shaanxi and Hunan were provinces of middle income level, and the proportion of rural population were very high, therefore, it has policy significance for the obvious increase of CT and MRI distribution in these two provinces.The study also found that per million population numbers of CT and MRI was positively correlated with the local economic development level in all samples, and the equipment number was greatly influenced by government subsidies.3, This study systematically described the present status of the utilization efficiency of CT and MRI in China, and analyzed the factors that influence the utilization efficiency of CT and MRI from multiple perspectives. Utilization efficiency of CT and MRI are different among different regions. Utilization efficiency of CT and MRI were positively correlated with regional economic development level.The utilization efficiency of CT and MRI in sample areas were lower than the international average level. The examination number per year was the major cause that negatively affected the efficiency, and short examination time might be the main reason of utilization rate of MRI. In contrast, utilization efficiency of CT was lower than that of MRI.Factors that influenced the utilization efficiency of CT mainly included:the hospital level, government subsidies, title of operators, etc. For MRI, the factors included equipment type, hospital level, whether imported equipment, average hospitalization days, geographical location, whether teaching hospital or not, title of operators, proportion of operators with on-job certificates, etc. For CT and MRI, the hospital level and title level of equipment operation personnel were both significant factors that affecting its efficiency with the same direction. The higher the hospital level, the higher the level of equipment operation personnel title, the higher the utilization efficiency of CT and MRI.4, This study described the status quo of utilization appropriateness of CT and MRI, and analyzed its influencing factors in multi-levels. The level of utilization appropriateness of CT and MRI in sample cities were high. In the inappropriateness judgement results, the percentage of overuse was less than that of underuse.The influencing factors of utilization appropriateness of CT were the level of hospital and disease category. The lower the hospital level was, the lower the level of utilization appropriateness of CT; and clinical records with pneumonia had a relatively low level of utilization appropriateness. The influencing factors of utilization appropriateness of MRI were not as clear as that of CT, and in hospital days might be one of the factors. The longer the in hospital days, the lower the level of utilization appropriateness of MRI.The influencing factors of utilization appropriateness of CT differed from different diseases. For the pneumonia records, the influencing factors of utilization appropriateness of CT were regions, hospitalization days and hospital level; for the lung cancer records, the influencing factors were whether the patient got surgery and disease station when hospitalized; for the malignant brain tumors, the influencing factors were hospitalization days.Results of qualitative interview suggested that the influencing factors of utilization appropriateness of CT and MRI might also include maintenance cost of imported equipment, absence of allocation and training of equipment operation personnel.[Suggestion]1, Keep the governments’macroeconomic regulation and control of the distribution and management of CT and MRI. Growing demand for health services and preference for major medical equipment in hospitals indicates a fast growth of the number of CT and MRI in China, and the cost of introduction will be higher and higher. The management of major medical equipment requires a high degree of macroeconomic regulation and control ability, and it is necessary for the governments to keep the right to control the distribution and management of CT and MRI.2, Refine the management of CT and MRI distribution and improve the equity status of CT and MRI distribution. At the present stage, the status of CT and MRI distribution according to the population distribution is at a high level, but there are still inequities in the level of equipment characteristics. According to the current policy, the management of major medical equipment management mainly focuses on the control of the overall number, and this may help to reduce the growth rate of major medical equipment such as CT and MRI, but there is no specific regulations for the equipment level, used years and should be imported or not. We suggest that the policy of major medical equipment management should be refined in this aspect.Attention should be paid both on the number and on the characteristics of major medical equipment.3, There are huge space for the improvement of utilization efficiency of CT and MRI from multiple perspectives. Studies have found that the utilization efficiency of CT and MRI were lower compared with the international level. Perspectives of clinical pathway management, equipment operating personnel technical level improvement, strict controls of admittance of major medical equipment in hospital, increase strength of large medical equipment subsidies in less developed areas should be discussed to realize the increase of utilization efficiency of major medical equipment.4, Attache more importance to scientific hospital management and the development of low level hospitals, and further enhance the utilization appropriateness of CT and MRI. Because there were both over use and under use of CT and MRI in China, we suggest the relevant departments develop detailed guidelines according to different diseases, or develop corresponding equipment using guidelines with different economic development levels, different level hospitals and different characteristics of equipment, to provide a reference for the rational use of major medical equipment; we suggest that relevant government departments and research institutes should do more targeted case assessments more actively to provide evidence-based support for the rational use of equipment; At the same time, in the process of continuous improvement of health insurance, it should increase the compensation for basic level hospitals as well as hospitals in the low economic level districts. This will help promote the scientific management of hospital and improve the utilization appropriateness of CT and MRI on the system level.5, Improve the policy and institutional construction and major medical equipment management system. In order to improve the efficiency of management of major medical equipment, we suggest that health administrative departments of different levels should be given moderate management responsibility in the administration of major medical equipment from the perspective of policy and institutional construction. Thus, health administrative departments of different levels can play their own role more actively; lessons from related foreign management experience can be drawn that mechanism of major medical equipment configuration, input mechanism, supervision mechanism and evaluation mechanism should be gradually perfected from the long-term view, and the equipment management efficiency will be strengthened. |
PDF Full Text Request