| Background: At present, a state of low technology, the weakly ability of county public hospitals and unclear function lead to the disorder treatment. In view of this situation, the pilot project of payment system reform was implemented in Yanchi and Haiyuan. Evaluation whether the Pilot program achieved the purposes of cost control, does service quality improved and reaching the classify diagnosis process target. Then finding the questions of this program and put forward the countermeasures and suggestions to promote the sustainable development of the program.Objectives: From the following three aspects, analysis the Pilot Program effects between before and during implementation, implementation and non-implementation, that are the hospital medical expenses, service ability, grading treatment. Finding the questions and deficiencies during the process then provide reasonable suggestions for improvement.Methods: Using inner and outer control method, analyze the effects between before and during implementation of Yanchi and Haiyuan County hospital. Take Zhongning and Tongxin county hospital as the control groups to analyze the effects between implementation and non-implementation. Descriptive and chi square and t test were used in the comparative analysis. Factor analysis is used for evaluation of patient satisfaction. Multivariate logistic regression is used to analyze the main influencing factors of grading treatment.Results: Inner control result: 1.The medical cost of Yanchi has been controlled efficiently while Haiyuan is not. The cycle ratio of total cost and average cost of Yanchi are decreased after implementation, the best department of medical control is infectious disease. The cycle ratio of total cost and average cost of Haiyuan are show uptrend, t test is>0.05.The amount of hospitalization and service ability were promote both in Yanchi and Haiyuan. Bed usage rate and bed turnover rate are close to the national standard. Proportion of large medical equipment and cumulative medical income are gradually increased. The financing and fund utilization rate of Haiyuan are higher than Yanchi. The proportion referral patients to higher authority in Yanchi is14.87, while in Haiyuan is7.36, The proportion referral patients to rehabilitation in the county is zero.Outer control result: 1.The cycle ratio of total cost and average cost of Yanchi are decreased gradually, while the same indexes of Zhongning have increased significantly. There's real evidence to prove pilot program really works on control medicine costs. Hospitalization rate of experimental group is lower than control group before implementation, while higher after implementation.About satisfaction: The Patient satisfaction was highest belongs to comparative satisfied, comprehensive score is 2.07, the next is management, comprehensive score is 2.39, the Medical staff satisfaction is in the last.Multivariate logistic regression analysis: There are six factors associated with diagnosis and classification, which is degree of education, distances from county hospital, be familiar with the doctor, medical technology level, and service attitude and reimbursement ratio. Among them, the technical level is the most influential factors, next is reimbursement ratio and distance from county hospital, the last is degree of education.Conclusion: The medical service ability is the key to complement classification diagnosis and treatment. There is really have the effects in enhancing the ability of county hospitals, while in medicine cost control only has the effect of Yanchi. In addition, the pilot program lacks of incentive for medical staffs.Suggestions: 1. The project team should investigate the county hospital ability every year and Put government input link to the hospital Ability.2.Re-adjust expenses calculation scheme full reference the view of Project implementation manager. In the measurement process, allow the individual indicators differ in different hospitals.3.Through economic incentives, strengthen the project approval and enforcement of Medical workers'4.Strengthening the functional orientation of medical institutions, severely restricting patients receiving standard of tertiary medical institutions, let patients of mild symptom go to primary health care institutions. |
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