The Effect Of Drug Zero-profit Policy On The Compensation Level Of The Hospitalization Department In A Tertiary Hospital

Since the reform and opening up,with the continuous increase of the national economy,residents' income,and aging,the people's desire for medical services has become higher and higher.However,the use of expensive imported drugs,the development of modern medical technology,and the investment in large-scale instruments and equipment have continuously accelerated the growth of medical expenses.With the continuous advancement of the reform of public hospitals in our country,especially the implementation of the drug zero-profit policy,the hospital is required to make sound adjustments to the compensation mechanism.The income of hospitalization as the main source of medical income for hospitals has also received increasing attention.However,most of the researches on the compensation level of public hospitals in China currently remain in the hospital's overall financial data and policy theoretical data,and there is a lack of quantitative research on the actual data of inpatient departments.Objective:By analyzing the changes in the cost of inpatient departments after the implementation of the drug zero-profit policy in a tertiary hospital,we studied the compensation levels of different inpatient departments from the perspectives of medical service price adjustment compensation and government financial subsidy compensation.In order to reasonably compensate for the policy-related losses in hospital drug revenues,fine management was carried out to provide empirical evidence for the drug zero-profit policy.Methods:In this study,the HIS data of hospital discharge records for the tertiary hospital in Shandong from June 2016 to May 2017 were used.Descriptive analysis and comparative analysis were used to compensate for the price adjustment of medical services for different hospital departments.,the government financial subsidies and the proportion of internal hospitals should be digested for analysis.Results:1.Changes in total medical income:The total medical income in the year after the implementation of the policy showed a trend of increase(10.88%).Outpatient and inpatient incomes both increased.The increase in hospitalization income(13.36%)was greater than the increase in outpatient income.3.62%).The amount of medical examinations,surgeries,and nursing care that represent the labor value of medical personnel has grown rapidly.The revenue and proportion of medicines decreased,but it is still the main component of hospital income(37%),among which outpatient(50.87%)and hospital(32.66%).2.The level of compensation for policy-related losses of hospital drug income:The overall drug compensation level of the hospital is 77.97%:4.47%:17.55%,which does not reach the theoretical compensation level of 8:1:1;the compensation for the price adjustment of medical services for inpatient departments,It accounted for 88.7%of the policy-related losses in drug income,while the outpatient department accounted for only 53.13%;the financial subsidies accounted for 4.47%of the loss of drug revenue.3.The level of compensation for policy-related losses of drug revenues in operative departments and non-operative departments:There is a difference in the level of drug compensation between operative departments and non-operative departments.Among them,the compensation for medical service price adjustment:in the operating department is higher than the policy theoretical value,which is 156.25%,while the non-operative department only accounts for 38.77%.4.The level of compensation for policy-related losses in medicine,surgery,gynecology,obstetrics,pediatrics,and traditional Chinese medicines:There is a difference in the level of compensation for medicines in various departments,and the ratio varies from high to low.Among them,the level of compensation for medical service price adjustment was higher than the theoretical value in surgery,gynecology,obstetrics,and pediatrics,which were 144.24%,268.16%,315.97%,and 91.48%,respectively;the adjusted compensation levels for internal medicine and traditional Chinese medicine were only 34.82 respectively.%,38.02%,large compensation gap.5.Different medicines account for the level of compensation for the policy-related losses of drug revenues in departments:There are differences in the compensation levels of medicines in various departments,and the proportion of compensation is high or low.From the low drug proportion department to the high medicine proportion department,the proportion of the compensation for service price adjustment to the policy income of medicine income gradually decreases.Among them,low-,medium-and low-medicine drugs accounted for 195.47%and 155.57%of the price adjustments for medical services in the special departments,which were higher than the theoretical values of the policies and could fully compensate for the policy-related losses in drug income;Only 21.12%,a large gap in compensation.Conclusion:1.Compared with the analysis of the hospital's overall financial data and policy theoretical values,the quantitative study of drug compensation from the perspective of the department can accurately calculate the policy-related losses of drug income in specific departments,and truly and accurately reflect the hospital The actual level of compensation.2.The price adjustment of medical services by the hospital can basically achieve the compensation value of policy theory,but the government financial subsidies are not in place.Among them,the proportion of compensation for the price adjustments of inpatient departments and outpatient departments is different,and there is a difference due to the difference in the reduction in price adjustments for large equipment.3.The increase in the total income of hospital medical services is related to the high proportion of total medical income and the high growth of the income of inpatient departments.It is also consistent with the fact that provincial hospitals focus on high-precision development goals and the development of outpatient services tends to be saturated.The reason why the proportion of drug revenue is still too high is not only related to the continued use of new drugs and drug treatment,but also related to the long-term effects of excessive drug use and policies.The improvement of the labor value of medical personnel will help improve the work enthusiasm of medical personnel.Be vigilant against the high inspection fees caused by the non-standard use of over-medical and high-value consumables.4.Due to the differences in the diagnosis and treatment methods and the use of drugs in various dqpartments within the hospital,the compensation levels of the various departments are different,and even some of the departments suffer serious losses.The operating department compensates for the loss of drug income policy by following the price increase of the surgery,while the non-operative department uses the drug treatment to cause a large compensation gap.The prices of gynecological and obstetric surgeries are much higher than those of surgery,and the proportion of large-scale equipment inspections is lower than that of surgery.Traditional medicine accounts for a relatively high proportion of drugs,and there is not enough surgical services to make up for the loss.The majority of pediatric patients are young children,and less use of large-scale equipment checks,so the compensation level for pediatric service price adjustment reaches the theoretical value of the policy.The price of traditional Chinese medicine services is low,and it fails to reach the level of theoretical medical service price adjustment and compensation.Low-,medium-and low-dose drugs account for less use of medicines than the proportions,and tend to be treated with non-drug treatments such as surgery,while middle-,high-and high-dosages account for the opposite proportion.With the continuous increase in the proportion of medicines,the propor;tion of service price adjustments showed a declining trend.Suggestions:1.Calculate the compensation level of hospitals and departments through actual data,accurately grasp the development status of hospitals,and the government can also give reasonable compensation to hospitals based on actual data to improve the utilization rate of compensation.2.According to the different methods of hospital diagnosis and treatment,there are differences in the allocation of financial subsidies to prevent financial subsidies from being concentrated in hospitals with excellent performance,and to improve the public welfare of the hospital.3.Strengthen the government's financial subsidy,refine the service program of the hospital,compensate the service amount,and subsidize the project,and apply the subsidy to a reasonable position in a timely and accurate manner.4.Conduct targeted and rational drug promotion,improve the prescription monitoring system,and standardize the medication behavior of medical personnel.Strengthen the cost accounting system for medical hospitals and departments to precisely match the revenue and costs generated by the price reform of medical services.Adjust performance appraisal standards,build service quality supervision systerm for all levels of hospitals and departments,and ensure patient satisfaction with medical treatment.