| BackgroundDue to the high-quality and abundant medical resources in Shanghai, they attract a large number of off-site patients, which result in the difficulty of getting medical service in Shanghai grade three A hospitals. Our country lacks the correspondingly service policies. Because our country’s medical insurance belongs to the local management, it is unable to achieve information sharing between the various regions at present. Off-site patients come to Shanghai for medical treatment need to pay all the medical expenses, then back to the medical insured region to apply for reimbursement, and are unable to get immediate settlement and also have to deal with many procedures, which cause great inconvenience to patients.ObjectiveBy analyzing the overall situation of off-site medical in Shanghai, learning the patients’structure, medical objective, costs and influencing factors of the patient satisfaction, discussing the current problems, providing a theoretical basis for future policy development and increasing the off-site medical patient satisfaction.Methods1. Literature reviewReviewing the domestic and international research and contrastive summarizing the differences and deficiencies, summarizing the management of off-site medical expenses in a theoretical research base. Investigating the problems of off-site medical through off-site patients’advantages and disadvantages and achieving the equality for medical treatment.2. Empirical ResearchSummarizing the off-site medical situation of Shanghai in 2010 to 2013 and analyzing its trends and costs. This research investigates the satisfaction of the off-site inpatients of two Shanghai grade three A hospitals. Using typical sampling method and questionnaire to investigate 433 off-site patients. The investigating departments include cardiothoracic surgery, neurosurgery, oncology, pulmonary and orthopedy.3. Statistic analysisUsing the SPSS 18.0 software to descriptive statistical analyze the composition of off-site inpatient’s age, sex, origin, education and health care, etc, and to count the satisfaction of overall medical treatment and various aspects of off-site inpatients. With overall satisfaction as the dependent variable, age, sex, origin, education, medical insurance, medical policy, reimbursement procedure, attitude, convenience, technology, care services and wait time as the independent variable, using the chi-square test and the logistic regression to analysis, setting the value of a is 0.05, investigating the influencing factors of satisfaction and cost burden of off-site inpatients.Result1. The numbers of off-site medical patients are increasing every yearThe person-time of Shanghai off-site medical outpatients average annual growth was 4.78% in 2010 to 2012. The off-site medical inpatients average annual growth was 14.67%. Compared to outpatients, off-site inpatients had higher percentage. The off-site inpatients in Shanghai tertiary hospitals accounted for 30.8% in 2011 and 30.93% in 2012. The proportion of some grade three A hospitals reached to 70% and 80%.2. The costs of off-site medical patients are increasingThe outpatients and inpatients cost of off-site medical were average annual increased 11.67% and 24.18% in 2010 to 2012. The inpatients cost of off-site patients in Shanghai tertiary hospitals accounted for 34.8% in 2012. The off-site patients cost of medical care per time was gradually increased and significantly higher than local patients. The outpatients cost per time of off-site medical was 47.51% higher than the city average and discharged patients cost per time was 15.37% higher than the city average in 2012.3. The off-site patients have low satisfactionThe survey results show that the off-site patients’overall satisfaction is low. There are about 29.33% patients are dissatisfied. The overall satisfaction’s average score was 4.20. Their dissatisfied aspects mainly in convenience(3.89), treatment time(4.32), wait time(4.18), attitude(4.56) and price(4.24). The off-site patients’most discontent is the convenient degree and 54.40% of off-site patients consider the inconvenient reimbursement is the biggest problem in off-site medical treatment. In addition, the off-site inpatients have heavy indirect cost burden and 51.96% of off-site inpatients are not familiar with the off-site medical policy.45.6% of off-site inpatients are dissatisfied with the current off-site medical policy.58.5% of off-site inpatients consider the cost of off-site medical is higher than local medical care.72.98% of off-site inpatients consider the cost reimbursement cycle is long.Through the logistic regression analysis shows that the overall satisfaction of off-site patients is related to the factors such as understanding the medical policy(OR=1.799, P=0.028), off-site medical policy satisfaction(OR=5.083, P<0.001), medical procedures satisfaction(OR=5.744, P<0.001), long reimbursement cycle(OR=0.421, P=0.006), convenience(OR=3.482, P=0.001), attitude satisfaction (OR=6.372, P=0.006), technical quality satisfaction(OR=4.109, P=0.027), treatment time satisfaction(OR=5.303, P<0.001) and wait time satisfaction(OR=2.272, P=0.036), etc.Conclusions and suggestions1. The reform of off-site medical management has made good progress in our country, but there are still some problems. The off-site patients are dissatisfied with medical procedures. There are still some issues such as heavy cost burden, long reimbursement period and unnecessary procedures. It is difficult to solve the contradiction between the insufficiency of cities with high-quality medical resources and large numbers of off-site patients.2. In short-term phase, we can adopt measures such as simplifying the medical procedures, shortening the period for reimbursement of medical expenses, improving the service attitude, ensuring proper treatment time, improving the quality of medical technology, popularizing the off-site medical policy and improving the procedures’ convenience to increase the overall satisfaction of off-site patients.3. In long-term phase, we can establishing the telemedicine service system, promoting the physicians multi-sited license, normalizing the regional two-way referral system, expanding the overall planning regional and achieving the national medical insurance information networking to solve the off-site patients problems. |
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