| BackgroundTraditional Chinese Medicine(TCM) is an important feature of Chinese characteristic medical and health undertakings. For thousands of years, TCM has made important contributions to the thriving of Chinese nation. However, with the economic globalization, scientific and technological progress and the rapid development of modern medicine, TCM faces with many new problems. Compared with western medicine service, TCM services has less quantity, lower price, and is more serious in loss. The low economic benefit of Service project restricts the positivity of medical institutions and medical personnel to provide TCM services. The application of TCM services is gradually atrophic.TCM features and advantages such as simple, easy, effective, and inexpensive plays an important role in primary health care system, has a significant effect on disease prevention and health care, alleviates the medical treatment difficult and expensive phenomenon effectively.From the medical reform, the government give full play role to TCM in China’s basic medical and health system building, promoted the development of TCM certain extent, but the policy effectiveness is very limited.Government compensation, drug charges compensation and medical services charges compensation is the main channel for TCM development. For a long time, The TCM institutions compensation based on drug income.public hospital reform cancel drug addition policy, the equivalent of cutting off the TCM institutions main source of income.TCM has the low price,small number, medical services charge can not become the main development of TCM compensation.TCM Sustainable development can not rely on market mechanisms, can only rely on government financial support.The research of compensation for medical services currently basic on one part of the compensation system, there exists many issues,such as compensation ways uncertain, compensation objectives wasn’t clear, difficult to quantify compensation standards and so on. And there are few studies financial compensation process design systematic。There is lack of empirical research in the financial compensation ways, compensation objectives, compensation standard, and the payment of compensation funds.The study have developed a system of financial compensation with the scientific compensation mode, compensation object, compensation standards and payment,as to provide reference to TCM financial compensation.This study puts forward four research questions:the way of financial compensation, the compensation object, the compensation standard and the payment method. They are specifically as follows:(1)what is the way of financial compensation? Is the supplier to be compensated or the buyer? Is medical institutions to be compensated or medical services?(2)Which or what kind of service does financial compensate? How to select the service project?(3)What is the financial compensation standard? How to balance the relationship between government financial pay ability, medical services operations and the incentive of medical staff?(4) How does financial compensation pay? How do channels complete the financial compensation and give full play to the efficiency of the financial compensation?ObjectivesThe general goal is to put forward supporting measures of government financial compensation and to supply references for promoting TCM development strategies through theoretical research and analyzing the mode of government financial compensation for Chinese medicine services. The specific goals are as follows: analyzing the financial compensation mode of TCM services of government by means of theoretical study; conducting comprehensive evaluation on Chinese medicine services and screening compensation object of Chinese medical service on the basis of cost accounting; analyzing and measuring the influence of different compensation standards on the government financial pay ability, medical services operations and the incentive of medical staff in order to determine reasonable compensation standard; building up a reasonable mode of financial compensation payment; putting forward supporting measures of financial compensation policy of TCM services and promoting the effective implementation of the financial compensation policy.MethodsThis is a cross-sectional study. The information is gathered from natural science fund projects named Chinese medicine services bringing into the basic medical and health services system guarantee mechanism research of Shandong province. The study includes both quantitative survey and qualitative survey and is completed in4-52009. Quantitative study is through the questionnaire survey, and the main content includes basic situation investigation of sample area, basic situation investigation of sample organization, the survey of TCM services and medical personnel questionnaire survey. Qualitative study uses semi-structured outline interview which focuses on TCM services in the region, and the agency about general application situation, influence factors, opinions and suggestions of the compensation for the services of TCM etc. producing further supplement and explanation of quantitative results through qualitative investigation.The study selects the county project Ningyang, Zhangdian, Qingzhou and Rongcheng in Shandong province as research samples.then selects each county sample from the level hospital and county level comprehensive hospital, and selects sample at random of2health clinics in towns and townships. In each of the health clinics in towns and townships,it selects sample at random of three village clinics.The total investigation include4at the county level hospital,4at the county level comprehensive hospital,8village clinics in towns and townships,24village clinics. This study investigates4at the county level hospital,4at the county level comprehensive hospital,8village clinics in towns and townships,24village clinics,319medical personnel of TCM of intention survey questionnaire and1160services project cost of TCM research. Use the method of qualitative interview54people.The study uses the method of medical service project cost accounting to carry out cost accounting of all of the Chinese medicine services and analyzes project of the profit and loss situation and cost situation. It uses two rounds of Delphi method to establish selection index system of compensation object, and uses the linear weighted synthesis method to determine the comprehensive evaluation value of the project, and then orders the project according to the size of the comprehensive evaluation value as the basis of compensation object selection.Main Results(1) Basic situation of Chinese medicine services in medical institutions:drug income which was dominated by Western medicine and Traditional chinese medicine income was the main part of the income of medical institutions. Revenues from the government and grant from the higher authority in the medical share of total income was very small, of which proportion were1.89%,5.50%and1.33%respectively in Traditional Chinese Medicine hospitals at the level of county, township and village. TCM Services revenue was relatively low in the three types of medical institutions, accounting for19.93%,9.20%and9.48%of the medical income respectively.The rate of carrying out TCM services items in medical institutions was not high. The average rate was48.57%,17.68%and11.94%respectively in county-level hospital of Chinese medicine, township hospitals and Village clinics. Judging from the types of items undertaken, massotherapy and acupuncture were carried out more extensive, external treatment of TCM and Chinese medicine special treatment etc. were not much.Meanwhile, the charging prices of TCM services were showing an increasing tendency with the rise of medical institutions grade, which was demonstrated as follows:the average price of TCM services in county-level hospitals of TCM was highest with316.45yuan which concentrated on10-20yuan and100-300yuan; the average price of township hospitals was130.75yuan which concentrated on0-10yuan and10-20yuan; the average price of village clinics was12.23yuan which concentrated on0-10yuan. There was an obvious diversity among different services of TCM. The prices of bone fracture and anorectum services of TCM were much higher than other services with the same grade while the average prices of external treatment, massotherapy, acupuncture of TCM were lower than other services with the same grade obviously.(2) The cost accounting results of TCM services:there was deficit in TCM services carried out by medical institutions to different extents. The deficit proportion of TCM services in village clinics was60%while the proportions of county-level hospitals of TCM and township hospitals both were30%approximately. Acupuncture and massotherapy took the most amounts of TCM general services deficit. In fact,100%TCM general services, more than50%acupuncture and40%massotherapy could not make up the actual cost with the prices.The fixed costs of TCM services carried out by medical institutions were higher than variable costs. The proportions of human cost and disposable material cost in total cost were very high, and these two types of cost are both showing an increasing tendency with the rise of medical institutions grade. The proportion of human cost was60%-70%approximately while disposable material cost was16%-31%. There was a difference among the cost composition of different TCM services. The proportion of disposable material cost was biggest in bone fracture and anorectum services of TCM. The proportion of human cost is biggest in acupuncture, massotherapy and general services of TCM.(3) Compensation choice:At this stage, especially since the new medical reform, the compensation pathway for demand-side is encouraging the use of TCM in the medical insurance. Some research and literature analysis found that demand side compensation policy of Chinese medicine services had been in place, but its role in promoting the development of Chinese medicine was limited. Therefore, this study focuses on the supply-side compensation mechanism of Chinese medicine services.The particularity and atrophy of Chinese medicine, the western issue of Chinese medical institutions, Chinese medicine medical staff wages and social status and other issues reveal the necessity of Chinese medicine services supply-side compensation.According to compensation object, the supply-side compensation is divided into compensation of medical institutions and medical services compensation. The study found that compensation of medical institutions was still the administrative compensation under the planned economic system, and it was only benefit for personnel, not for the supply-side service enthusiasm and the efficiency of health resources. Therefore, this study proposes compensation for Chinese Services items. This method is conducive to improve the enthusiasm of the supply side of Chinese medicine services, reduce financial costs and management costs, and better achieve the purpose of financial compensation.(4) The compensation object filtering:the compensation objects index system was created by two cycle of expert consultation and consisted3first-level indicators and10secondary-level indicators. The first-level indicators are economic value, social value and application value. The weight of index system indicated that the filtering should focus on its economic value of the services, followed by applications and social values. Secondary-level indicators are profit on the item, the technical value, the marginal rate of safety, item fees, the number of institutions, amount of services, whether the item is suitable to carry out at the institutions, whether for common and frequently-occurring diseases, items effect and the value of the items. The screening results showed that the vast majority of acupuncture, massage, bone-setting project had the priorities for financial compensation. For the reason that compensation in accordance with the individual items is complicated and cumbersome, this study proposes to take to the project category as a unit to operate package compensation. The acupuncture, massage, Chinese medicine Manipulation was priority included in the financial compensation.(5) Compensation criteria:It is not possible at this stage to take the price and the cost gap as compensation basis, the study proposed the average price of Acupuncture, massage, Chinese medicine Manipulation as the basis of financial compensation. The study measured12compensation proportion, respectively10%,20%,30%,40%,50%, 60%,70%,80%,100%,150%and200%of the average price of the three types of service packages, and analyzed the impact of the different type of compensation proportion to the Government’s financial ability to pay, medical services operating conditions and the medical personnel incentive extent, in order to determine a reasonable proportion of financial compensation.When the price is up to50%of compensation service, it can make up the defective item to the greatest and can make more than80%of defective item in county hospital of Chinese medicine, Township hospitals and village clinics break even or even profit. What’s more, when the compensation reach to50%, all the TCM projects carried by medical institutions are profitable, the profit was2.69yuan,2.00yuan,0.87yuan respectively.As the compensation of the three types of project in county hospital of Chinese medicine up to50%, it will encourage the service enthusiasm of medical staff. When the compensation of acupuncture and massage projects in township hospitals was50%, the physician services enthusiasm was inspired, so was the Practices reconstructive project of TCM when the compensation was60%.From the perspective of incentive coefficient, the encouragement to doctor in village clinic of compensation was the least, only until to200%, the encouragement appeared. However, due to the low original salary of village doctor and incentive coefficient, when the compensation up to50%, the incentive coefficient has already doubled, hence, the compensation could produce encouragement.Through the aggregate analysis of influence of pecuniary compensation on this three types, our study proposed that compensation proportion should be set at the50%of average price of practices reconstructive project of TCM, Acupuncture and moxibustion program, Massage project.(6) Payment options:the study suggested that the first task was to establish scientific and reasonable evaluation indicators system in order to assess s to the services provided by medical institution, evaluation cycle was every six months, and give compensation according to the assessment results. The evaluation indicators system contains infrastructure construction, talent team construction, The technical level and the business, organization and management and so on, in the light of their standardization, innovation, quality, quantity.Financial compensation funds should shared by national, provincial, municipal, county,4financial level, according to their development level of economic. The compensation funds adapt the way of combining payment in advance and post-paid, the governments at all levels allocate a certain amount of start-up capital and evaluate project situation at regular intervals, then according to the assessment results to examination and evaluation and allocated the compensate.Conclusions and SuggestionsThe developing and operating of TCM services are facing many problems in Chinese basis medical institutions. Compared with western medicine service, there were less service projects of TCM and the lower development rate. Medical service price is low, many items of charge price cannot cover the cost of the project, the loss is serious. The low economic benefits of TCM services restricted the enthusiasm of basis medical institutions and medical personnel to provide Chinese medicine service. The development of Chinese medicine service needs government policy, financial and institutional support and so on, but high financial investment didn’t improved the development of the traditional medicine a lot. So must be designed to build scientific and reasonable financial compensation mechanism, including compensation ways, compensation objects, compensation standard and the way of payment, in order to play a more effective efficiency of government financial investment. The research showed that should compensate TCM services to support the financial to support for TCM, should compensate the projects of acupuncture, massage and the technical features of traditional Chinese Anaplasty in priority to promote the extensive, service capacity, demand is big, easy, cheap, effective service to provide and use. The research showed that should compensate the50%average price charged as compensation standards to three types of service packages including acupuncture, massage, the technical features of traditional Chinese Anaplasty respectively. Under the ability of the county-level government to pay, can make up more than80%of the loss items, make it cease to lose and begin to turn out a profit and get the best cost-effective moreover will inspire the enthusiasm of the medical staff to provide Chinese medicine services. Meanwhile financial compensation should be based on the evaluation and assessment of the service, to evaluate the service of medical institutions according to the evaluation index system and compensate at the different levels based on assessment. Take the combination "advance" with "post-paid" as the payment way, recommend that nation, province, municipal and countyour levels to pay the compensation funds together.To give full play to the role of financial compensation, besides a reasonable financial compensation system, need to need to complement and support role of other supporting measures.(1)Establish a sound supervision mechanism corresponding, passes through the assessment and evaluation of medical institutions, the implementation of compensation funds at all levels of government, the management of the compensation usage, to implement the compensation funds and make it working completely.(2) Strengthen the compensation and policy for buyer, continue to promote the width and depth of the participation of Chinese medicine in various medical insurance policy.(3) Adjust the TCM services prices:first, on the basis of investigation and complete cost accounting, adjust the TCM services fees price properly, totally reflect the real value of technical services of TCM and traditional Chinese medical personnel’s value; secondly, to shorten the TCM services price adjustment period, make the price fit to the actual cost,economic development, The level of price increases and the needs of the people.(4) Improve the TCM services project cost accounting:first, to explore the method of cost accounting ways can reflect the characteristics of Chinese medicine medical service; secondly, establish a unified cost accounting system, the results of this system will be comparable, improve cost accounting results comparability. |
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