Research On Current Situation And Control Strategy Of Medical Sanitary Materials Used In Public Hospitals

With the development of clinical diagnostic technology and examination, medical sanitary materials which are used more and more in the process of diagnosis, treatment, testing and care, is considered to be an important factor influencing health costs. The use of medical sanitary materials is related to hospital administrators, health care personnel, patients with different knowledge, attitude and behavior of the three parties, as well as related to the balance and game of gains among third party groups. In addition, Government policy of price and control systems, medical insurance policies in the management and use of medical hygiene materials also play(necessarily) effects. The income of medical sanitary materials in public hospitals as the subjects in medical services is increasing faster in revenue and which has become the attention to control unreasonable increase for medical payment. ObjectiveBase on price regulation theory, information asymmetry theory, game theory and health resource allocation theory, this study selects Hospital Y in J Province as an example to start an empirical research on current situation, the influencing factors on the usage and supervision of medical sanitary materials are comprehensively explored from the aspects of hospital(administrators), health care workers and patients. It provides reference and decision-making proof for the government to regulate the usage of medical sanitary materials in public hospitals and to make and carry out effective supervising measures and reduce the costs of medical sanitary materials. Method1. Conducting descriptive analysis and comparative quantitative analysis:by the method on the detail hospitalization costs of inpatients in 2011 through 2013 to understand the current medical sanitary material usage and expense situation in the public hospital, and the impact of clinical pathway on medical sanitary materials costs;2. Phenomenological method: by browsing data on-site field visits through reading and information recording to understand the medical sanitary material regulatory system and implementation in Y hospital;3. Focus group qualitative interviewing: through one-on-one interviews with hospital staff to understand the factors influencing the health care workers choose to use medical sanitary materials, as well as medical behavior of medical staffs and management consciousness of hospital administrators on the use and regulatory impacts of medical health materials;4. Questionnaire: questionnaire survey of inpatients in learning about informed and alternative in process of using sanitary materials, and exploring factors effect on the selection and use of hygienic materials;5. Mathematical model analysis: establish patients-government game model and patients-hospital game model, by analysis of the game process to elaborate that strategies effect on the use and regulatory policies in the course of medical hygiene materials usage. Result1. Data analysis results of sanitary materials costs(1) Inpatient medical materials cost per capita shows a rising tendency year by year for 3 years, accounting for 22.3%, 23.4% and 22.9% respectively, and takes a large proportion of the total medical cost of hospitalization second only to drugs; medical materials costs per capita for 3 years are 3400 yuan, 3800 yuan and 4500 yuan, and the annual growth rates are 16.04% and 10.18%, exceeding the annual growth rate of drug costs(4.79%、3.22%); general medical material costs and high value medical material costs in medical expenses accounted for ratio were the poles of development trend, the proportion of high value medical material costs increased year by year for 3 years, accounting for respectively 9.1%, 12.7%, 15.5%, and taking increasingly proportions among medical sanitary materials accounting for 40.58%, 54.17% and 67.44% for 3 years.(2) Among high value sanitary materials, the materials for vascular interventions, orthopedic implants and surgical instruments are the top three categories according to quantity and cost, accounting for 34.40%, 26.86% and 14.36% respectively; in terms of vascular intervention materials, it is stents that cost top per capita, and for 3 years the costs are 21.1 thousand yuan, 23.1thousand yuan, 23.3 thousand yuan; the top fee per capita of orthopedic surgical materials is artificial joints, and for 3 years the costs are 23.6 thousand yuan, 24.5 thousand yuan, 25.0 thousand yuan.(3) From the perspective of gender, male patient per capita hospitalization expenses and also medical materials costs are higher than that of female; from the perspective of age, it is the highest in patients with 60~79 years old whose cost of high value medical materials per capita accounting for 24.56% of medical expenses per capita, followed by 40 ~ 59 years old patients(24.04%), children under the age of 14 cost the least on medical materials(17.79%);(4) From the perspective of the medical insurance, the per capita medical materials costs all show a growth trend in 3 years of various forms of payment. The per capita medical material costs of patients with medical insurance for urban workers accounted for per capita medical costs of proportion respectively for 22.1%, and 22.5%, and 24%, is continued growing, indicating that the growth rate of per capita cost of medical materials exceed that of per capita health care costs; for 3 years patients with medical insurance for urban workers cost highest on per capita high value medical materials spend, followed by patients with urban residents medical insurance, while patients of new cooperative medical system(NCMS) cost the least.(5) From the perspective of different disease system, the per capita medical materials expenditure on surgical patients and their share in medical expense exceed the costs of patients from other systems; for 3 years medical material costs per capita of medical expenses per capita ratio for patients from medical system take an increasing percentage year by year, and its growth rate is faster than that of per capita health care costs. For 3 years, of every system, per patient spending on high-value medical materials shows an increasing trend. Per capita high value medical material cost is growing fastest in medical system, which of per capita health care costs ratio rise from 21.0% in 2011(0.80 million) to 45.5% in 2013(2.08 million).(6) After the implementation of clinical pathways, medical materials costs in patients with acute appendicitis and adults with community-acquired pneumonia than those change significantly(P <0.05) before the CP, in patients with acute appendicitis medical materials expense is estimated expenses decreased 2.96%, adult community acquired pneumonia of medical materials expense is estimated expenses decreased 33.89%.2. Results of on-the-spot investigationIn terms of construction of management facility and system of use and control, most of the processes developed in medical hygiene materials in Y hospital can be carried out in accordance with the requirements of the national laws and regulations, and rules and regulations established depending on the different management content of every link such as permitting process of argumentation, on trail by clinical, procurement tenders, logistical management, procedure of appliance and charge management. But there is no barcode tracking and detailed management procedure in acceptance, using and charges process of high value material outside tender for emergency surgery or special illness need; in the construction of logistical information network, there is no sharing communication in the links of charging items and items on directory of health insurance; reports number of adverse events is less than the number that actually occurred.3. Results of qualitative interviewsMedical staffs can select and use medical materials according to the needs of illness and treatment programmes, which is influenced mainly by factors of the nature of material itself( the price, quality and technical characteristics) and economic conditions of patients and their families, or the affordability of patients with medical insurance forms; health care workers generally consider that informed consent is necessary before using medical materials, which can effectively prevent medical disputes; hospital administrators believe that strengthening the supervision of medical materials will help to reduce hospital operating costs, meanwhile, strengthening communication and interaction between clinical and hospital management personnel will be beneficial to process management, in addition, it makes difficult to manage the usage and supervision of medical materials due to absence of quantitative standard and assessment index in hospital.4. Results of Questionnaire70.6% of 582 patients are conscious of controlling medical costs, and a significant different shows among in different income monthly(P <0.05); 73.4% of the patients are concerned about changes of medical cost, patients’ concerns of medical costs vary with types of payment and occupations(P <0.05), those who are concerned the medical costs most are patients who work in government, party organizations and enterprises and institutions, while patients from military get the minimum attention on medical expenses; patients pay attention to various kinds of medical costs with different attitude, and 79.2% patients pay close attention to the fee on medicine, only 32.3% patients give attention to medical materials costs, which is the fifth in 6 types of expense consciousness. Types of payment have a significant impact on the concern of patients on medical materials costs(P <0.05), in the three major medical insurance payment, 62.9% of the patients covered by new rural cooperative medical insurance concern about the cost of medical materials, significantly higher than those with other forms of payment. Before using medical materials, 68.0% of doctors describe the different characteristics of the medical materials to patients and 62.0% of doctors introduce price to patients, 69.8% of patients make decision based on doctors’ advice, but there are still 10.1% of patients take the choice of other patients into consideration; 63.4% of the patients tend to rationally choose the cost-effective products.5. Results of mathematical model analysisDuring the using of medical health materials, patients and government of game checks and balances relationship reflected in patients’ strategy select of moderate using medical health materials and government optimal decision of regulatory probability, while patients’ returns of moderate select medical health materials is greater than non-rational select returns, regulatory cost of government is minimum; patients and hospital of game checks and balances relationship reflected in hospital’s strategy select of moderate using medical health materials and patients’ optimal select of accept strategy, hospital returns of moderate using medical health materials is greater than excessive using returns, patients have more opportunity to get proper treatment. Conclusions1. Medical materials costs account for the proportion of the total cost of hospitalization only after expenses for medicine, growth rate of medical materials per capita has exceeded the per capita cost of medicines and per capita hospital costs, and become the second-leading cause of medical costs. Growth of high value medical materials cost is a major factor affecting the growth of medical materials cost.2. Factors affecting the cost of inpatient medical hygiene materials include the patient’s age, sex, therapy, medical insurance forms and claims ratio; clinical pathway can reduce the quantity of single-disease in medical hygiene materials.3. Sound management system is the basis of medical sanitary materials safe use; advanced informationization of logistics network can effectively reduce the management cost; The traceability management of bar code ensures the safe use of high value health materials; Also strengthening management may reasonably reduce the cost of medical hygiene materials. Lack of use, control and regulation of quantitative indicators affect the hospital’s effective supervision of medical sanitary materials.4. Medical staffs select medical sanitary materials focus on illness and treatment programme, for patients with inadequate attention to; prices of materials and payment capacity of patients limit both choice of doctor and patient; patient’ attention and control awareness of medical sanitary materials is clearly insufficient. Most patients follow the recommendations of doctors and nurses to choose medical sanitary materials and the group psychology impact them to make the right choice.5. Through game analysis the using process of medical health materials, the optimal probability select which increasing patients rational behavior of selecting medical materials and reducing regulatory cost of government is to make patients who selected rational medical materials achieving maximum returns in treatment, so it strengthening on reform of patients medicare fund using, meanwhile, enhancing fairness of reimbursement among different medicare treatment can effectively reduce patients’ non-rational behavior of selecting medical health materials; the optimal probability select which reducing hospital excessive using health material in treatment and increasing patients to accept equal treatment is to ensure hospital profit maximum returns from moderate using medical materials, improving the quota of Medicare Fund payments and reducing operating costs of hospital can reduce phenomenon of excessive using materials by hospital. A variety of measures will be taken to relieve the financial burden of patients.