The Study On The Zero-profit Policy For Drugs On Medical Expenditure Of County-level Public Hospitals In Ningxia Province

BackgroundDuring the planned economy period,the government formulated the drug addiction policy to allow the hospital to compensate for losses from their low-cost provision of medical services by the way of the drug addition policy.Due to the fact that the government highly controlled the development of the hospital,the population mobility was small and the drug price was fixed at that time,the effect of drug addition policy was obvious.However,with the change of its policy background,the malpractices of drug addiction policies such as drugs to support medical services,public welfare dilution of the hospital and high expense in medical care are high-lighted.To this end,the state has formulated a series of public hospital reform programs.Among them,in order to get rid of the drugs to support medical services and reduce the burden of medical treatment for patients,public hospitals are required to gradually implement the zero-profit policy for drugs.However,with these uncertain factors which the information asymmetry between doctors and patients,the doctors' absolute influence on the volume of medical service and medicines,may still aggravate the medical expenditure of patients.Therefore,whether or not the zero profit policy for drugs can really get rid of the drugs to support medical services and reduce the burden of medical treatment for the patient remains to be further studied.ObjectivesAnalysis of the operation status of hospitals and changes in medical expenditures and It's internal components before and after the implementation of the zero profit policy for drugs in county-level public hospitals in Ningxia Province;explore key factors of affecting patients' medical expenditures and analyze the influence mechanism of the zero profit policy for drugs on medical expenditures.To promote the benign development of county-level public hospitals,to improve the zero profit policy for drugs provides a reference basis.MethodsThe trend analysis method is used to describe the change of medical expenditures in county-level public hospitals before and after the implementation of the zero profit policy for drugs;the composition change degree is used to analyze the changes of the internal structure of medical expenditures before and after the implementation of zero profit policy for drugs.By constructing multivariable linear regression model to analyze the influence factors of medical expenditure before and after the implementation of the zero profit policy for drugs and analyze the mechanism of the policy on the medical expenditure.Results1.The effect of medical expense control is not obviousAfter the implementation of the policy,the medical expenditures increased every year and the growth rate decreased,the expenditure of Western medicine is decreasing in total drug expenditures,and the expenditure of the traditional Chinese medicine is increasing;the medical expenditures of outpatient service are 385.91 yuan before the implementation of the policy,and increase to 589.45 yuan after the implementation of the policy,its growth rate is faster;hospitalization per capita medical expenditures by 2640.08 Yuan before the policy implementation,increased to 3946.67 yuan after the implementation of the policy,the growth rate slowed down;the proportion of health materials in hospitalization and medical expenditure was higher than before policy implementation;the proportion of health material fee in inpatient medical expenditure is higher than before policy implementation.2.The change of medical fee structure after policy implementation is large,but the function of cost structure optimization is limited.The changes in the structure of outpatient and inpatient medical expenses were 17.61% and 18.61% before the policy was implemented,and fell to 9.91% and 14.77% after the implementation of the policy;after the implementation of the policy,the western medicine fee and the laboratory fee is changing positively,its proportion in the total expense has risen in the outpatient medicine expenditure;the western medicine fees,the inspection fees overall negative change,laboratory fees are positive changes in the inpatient medicine expenditure;the expenditure of the traditional Chinese medicine in outpatient and inpatient medical expenses showed positive change in general,which indicated that the proportion of medical expenses increased;the structural changes of cost of operation,nursing,treatment and so on are small,and they show negative changes,which indicates that the technical value of medical personnel is not fully reflected,and the structure optimization effect of hospital cost is not obvious.3.Changes in cost items with high contribution rate to medical expenditure changes before and after policy implementation.Before the implementation of the policy,the increase in the cost of outpatient medicine is drug fees,inspection fees and laboratory fees,the cumulative contribution rate of 75.97%,after the implementation of the policy into drug,treatment,inspection fees,the cumulative contribution rate of 88.65%;the increase in outpatient drug costs is the cost of drugs,laboratory fees,health materials,the cumulative contribution rate of 72.86%,after the implementation of the policy into the cost of goods,treatment and laboratory fees,the cumulative contribution rate of 67.62%.4.The cost of representing the disease is different before and after policy implementation.The difference in the influence of the zero profit policy for drugs has different effects on medical expenses of patients with representative diseases.Inspections,laboratory tests,and drugs were the major items constituting the patient's medical expenditure,with the proportion exceeding 60.00.5.The influence factors of medical expenses were basically the same before and after the policy implementation,but the degree of influence changed.Before the implementation of the policy,the influencing factors of hospitalization expenses were ranked as the proportion of drug,hospitalization days,age,hospitalization times,hospitalization condition,and the regression coefficients were 0.247,0.306,0.102,0.035 and 0.067 respectively.After the policy was implemented,the days of hospitalization,the proportion of drug,the age,the method of payment,when hospitalized,the regression coefficients were 0.283,0.215,0.096,0.076 and 0.065.Recommendations1.The scope of medical services and adjust the accuracy of the project should be expanded and proved.2.Medical insurance system should give full play to the guiding role of to health care behavior.3.The government should strengthen the supervision and examination of the using of basic drugs and consumables in county-level public hospitals.4.Hospital service capabilities should be further improved and curb the impact of controllable factors on medical expenditure.