Analysis Of Medical Service Behavior Of County Hospitals In Z Province Before And After The Medical Pricing Reform

ObjectiveFocus on medical service behavior study,by comparing the changes of 8 county public hospitals in Z province before and after the medical pricing reform(from 2008 to 2013)about the hospital income and expenditure and cost components.Using economics and other related theoretical analysis of factors that affect changes of medical service behavior,to explore effective ways to achieve the objectives of the reform,and provide a theoretical basis for further reforms.Method1.Theoretical Study.Build issues with literature research and policy research methods,clear the boundaries of study,refine the main theoretical basis of the research questions,then propose theoretical assumptions and comb the relevant information about the public hospitals policy reform and the implementation effects,and analyze the relationship between effectiveness analysis and environmental policy and supporting measures to provide a basis for the present study.2.Empirical Study.Establish the evaluation of clinic institutions behavior in economics model and study variables,collect data and related indicators of financial expenses of 8 county public hospitals in Z province from 2008 to 2013 before and after the reform and analyze the changes of medical surgery and non-surgical disease.Test the hypothesis with qualitative and quantitative research combination,apply and check Epidata3.0 input data double.Use SPSS Modeler statistical Analyze data with Statistical description,T test/U test and correlation analysis to find factors.Result1.On the whole,after the reform the number of workers,beds,patient visits inpatient admissions all increased,but average days of hospitalization reduced.2.After the reform hospitals' drug income accounted decreased to varying degrees,the proportion of income medical increased,but financial compensation increased while decreased,G hospital where the largest government investment,financial compensation percentage was 14.7%.In general,there was no significant difference among of financial compensation income,medical income and drug income before and after the reform.3.After the reform,the total revenue and total expenditure of the hospitals increased significantly,an increase proportion of 38.1% and 27.4% above respectively.Aggregate balance was significantly higher than D hospital after reform than before(p <0.01).4.After the reform the staff expenditure rates increased(the average percentage of increase was 3%).The expenditure on wages increased,the average increase ratio was 1.8.The performance data allowance after the reform was significantly higher than prereform(U test,p <0.05).5.After the reform the drug income accounted decreased,the average decline was 11.1%,of which F hospital's drug income accounted for most significant decline in 15.7%.The ratio of cost of diagnosis and treatment,nursing has been improved6.After the reform the medical costs of 3 medical institutions' cerebral hemorrhage,benign gallbladder and cesarean rising in varying degrees,in which D's medical expenses were significantly higher than those before the reform,gallbladder surgery and cerebral hemorrhage's fee in C was increased,but significantly lower than D hospital.From the view point of cost structure,C and G were not only significantly decreased in proportion of drug,but also significantly in drug costs.D hospital cerebral hemorrhage surgery(drug ratio from 43.3% down to 34.8%,the cost of drugs promoted by 9631 yuan raised 10,096 yuan)and surgical benign gallbladder's(drug ratio from 33.6% down to 27.6%,the cost of drugs promoted by the 2666 yuan 2723 yuan)drugs accounted declined,but the drug costs raised cesarean and medicine cerebral hemorrhage drug costs had a smaller decline.7.The total revenue of the hospital correlation coefficient weights showed that the correlation coefficient of government financial assistance and total revenue increased from 0.435 to 0.735 after reform,and drugs expenditure by the pre-reform coefficient dropped from 0.979 to 0.471.Other weighting factor had little change.Conclusion1.Overall,the 8 pilot hospitals medical pricing reform has achieved good results.All hospitals' medical expenses had no significant growth before and after the reform.The proportion of drug was decreased,but the proportion of labor costs increased,the original of revenue and expenditure turned drug income into medical-based income.2.View of medical service behavior,D hospitals still existed profit-driven and cost –transfer,it had suspects of providing over high price of medical services and need to establish a reasonable regulatory mechanism.C was committed to improving the quality of hospital-based medical services,its reform results was better than D,but its revenue essentially flat,surplus insufficient,so as to avoid the management risk of reform brought to the hospital,C should be strengthened in the implementation of reforms while improve the efficiency of medical services,reduce waste of medical resources.