Research On The Effect And Countermeasures Of Global Budget In The Private Hospitals

Objective: Based on the new public service theory, this study aims to find out the favorable and adverse effects of the total prepayment system on the development of private hospitals through analysis and investigation of the medical insurance payment system and the implementation of the total prepayment system in foreign and domestic areas. It also aims to make suggestions for private hospitals in similar size.Methods: In this study, through analysis the working efficiency, service quality and medical cost data of one private hospital in Changchun city from 2010 to 2014, it aims to understand the effect of the implementation of the total prepayment system of medical insurance.The questionnaire survey was conducted to investigate the knowledge and behavior attitude of the total prepayment system in medical workers. The interview of the hospital managers was also done to analysis the effect of the total prepayment system on hospital operation and to define the existed problems in order to puts forward strategies for the operation of private hospitals under the policy of total prepayment.Results: 1. Work efficiency analysis: From 2011 to 2014, the average number of hospitalizations increased, the average length of stay reduced and the average bed turnover increased, indicating that work efficiency improved after the implementation of the total prepaid system. 2. Quality of service analysis: From 2010 to 2014, among the hospitalized patients, the number and proportion of patients CD and internal fixation patients had an increasing tendency per year, which indicating that Quality of service improved after the implementation of the total prepaid system. 3. Cost analysis: From the structure of drug costs and costs, the total amount of drug costs still increased, but the proportion of drugs declined year by year after the implementation of the total prepaid system, indicating that the total prepaid system had effect on controlling costs. 4. Knowledge, Attitude and Behavior of Medicaid Prepayment System: In this survey, the awareness of prepayment method, prepaid fund allocation plan and medical insurance assessment index of medical staff were lower, which were 50.00%, 68.76% and 71.88% respectively. The majority of medical staff believed that the total pre-paid hospital system would affect the number of patients, the turnover rate of beds and the ward's overall income, accounting for 53.13%, 62.5% and 75.00%. Up to 62.50% of the medical staff were opposed to hospital to the implementation of the total prepaid system. The total prepayment system had a significant impact on the doctors' medical behavior, 53.13% of the medical staff chose to improve the standard of admission and 34.38% chose to reduce the number of examination. 5. Hospital managers believe that the combined prepaid system and other payment methods were more effective.Conclusion: Under the background of The New Policy of Medical Care Reformation, the global budget has become the main insurance payment method in our country at present stage. Our results show that medical expense was remarkable controlled, the hospital work efficiency improved, the service quality improved steadily, the number of the discharged patients increased, the use of beds increased, the average hospitalization duration descend, the CD type and internal fixation surgery in patients increased, the cost structure continually optimized and the drug cost decreased after the implementation of the total prepaid system.The results of Questionnaires and interviews showed the knowledge of hospital staff was not enough and the hospital managers felt big pressure about the control of medical expense. Therefore, taking patients as the center, finding the balance between the cost and treatment and exploring the total payment system with other means of payment are needed. It is important for private hospitals to be effective supplement of public hospitals and to make corresponding contribution to our country to solve the problem of difficulty and high cost of treatment by using the advantage of price and service, enhancing internal management, making full use of guarantee funds and controlling reasonable medical cost.