Research On Evaluation Of Single Disease Payment's Implementation Effect In Anhui Province

Objectives The planned cesarean section was taken as the research object to evaluate the single disease payment's implementation effect in Anhui Province.Analyzed the changes of hospitalization expense,key quality indicators and influencing factors before and after the implementation of single disease payment.Explored the deficiency of single disease payment and provided references for the further implementation and improvement of single disease payment in China.Methods 11 county-level public hospitals in central part,southern part and northern part were selected as samples in Anhui Province.1211 samples in the control group(no single disease payment)and 779 samples in the experimental group(implemented single disease payment)were collected by field investigation.The cost of inpatient information was derived from the platform of new rural cooperative medical system Information System in Anhui Province.Patient basic information was collected with self designed questionnaire.Each sample data was constituted by the above two kinds of information.Then completed the double data entry with Epi Data 3.1.Two independent-samples T test,Mann-Whitney U test,Chi-square test and Ordinal logistic regression model were used to analyze data.Explored the deficiency of single disease payment with interview method in China at the same time.Results(1)After the implementation of single disease payment,the average hospitalization expense decreased by 143.28±50.97 yuan(P<0.05),the average medicine expense decreased by 220.17±30.69 yuan(P<0.05),the average inspection fee decreased by 46.99±4.16 yuan(P<0.05)and other expenses decreased by 82.33±6.13 yuan(P<0.05),the average operation expense increased by 119.54±8.88 yuan(P<0.05),the average treatment fee increased by 51.60±8.52 yuan(P<0.05),the average nursing fee increased by 16.62±6.82 yuan(P<0.05).(2)After the implementation of single disease payment,the composition of hospitalization expense has changed.The results showed the proportion of medicine expense,examination expense and other expenses decreased by 4.00%,1.00% and 2.00%.The results also showed the proportion of operation fee,treatment fee,nursing expenses increased by 3.00%,2.00%,1.00%.The proportion of bed fee,laboratory fee and anesthesia fee were no change.(3)After the implementation of single disease payment,key quality indicators have changed.The average length of stay reduced from 7.46±2.34 days to 6.13±2.66 days(P<0.05),average days of abnormal temperature reduced from 0.96±1.21 days to 0.78±1.11 days(P<0.05)and average time of using antibiotic reduced from 4.22±2.30 days to 3.69±1.75 days(P<0.05).The rate of antibiotic combination reduced from 28.41% to 1.54%(P<0.05)and the rate of intraoperative blood transfusion reduced from 2.39% to 1.54%(P<0.05).The rate of cure was increased(P<0.05).(4)Analyzed and compared the factors of hospitalization expense with the ordinal logistic regression model.The factors of the control group(no single disease payment)and experimental group(implemented single disease payment)were almost the same.The same factors were area,length of stay,“better outcome” and the time of antibiotic use in the control group and experimental group.The risk of area and “better outcome” in the control group was higher than the experimental group.The risk of length of stay and the time of antibiotic use was lower than the experimental group.In addition,the education and the number of neutrophils were the factors in the experimental group.If the other independent variables were fixed,there were following results: Central part and southern part has higher risk than the northern part.The more the length of stay were,the higher the hospitalization expenses were.The “better outcome” has higher risk than “other outcome”.The more time antibiotic used,the higher the hospitalization expenses were.The higher education was,the higher the hospitalization expenses were.The higher number of neutrophils were,the lower the hospitalization expenses were.(5)There were a series of problems to be solved urgently in China.The single disease payment was unable to deal with disease variation effectively.The compensation standard was unreasonable.Medical institutions,physicians and patients just paid a little attention to the single disease payment.Medical institutions had many limitations.The clinical pathway was rough.There were no effective supervision and assessment measures.(6)According to the results of research,we should expand the single disease payment pilot work,upgrade medical insurance payment,make scientific and reasonable compensation standards and implement the fixed and floating incentive mechanism.We also should establish a scientific and reasonable evaluation mechanism based on quality and effect.The government should take the clinical pathway as a part of the system to improve the single disease payment.Conclusions Single disease payment has reduced the hospitalization expenses in patients with planned cesarean section and optimized the structure of hospitalization expense.The key medical service quality indicators have been improved and the factors of hospitalization expenses were stable.But the single disease payment also faced a series of problems to be solved.