The Construction And Empirical Study Of Pediatric Input's Index System Based On Resource-Based Relative Value Scale

Objective:Referring to the approach of Resource-Based Relative Value Scale(RBRVs)of Harvard University,this study was aimed at constructing RBRVs index system for Chinese pediatrics and evaluating part of pediatric medical service relative value.The salary reform scheme of public hospitals was proposed based on our RBRVs index system,applicated in the pilot hospital and evaluated.Method:Literature analysis was used to analyze previous studies,and the RBRVs model hypothesis for pediatric medical services was established,which was verified in three stages.The first stage uses the Delphi method to preliminarily prove the hypothesis.In the second stage,a questionnaire was used to select the clinicians of the pediatrics related major in six hospitals in Xiamen,and the ratio of the medical services to the benchmark was evaluated by the expert scoring method.Linear weighted method was used to calculate the total work and occupational risk,and least squares method was used for professional connection.The multiple linear regression model was constructed with the relevant factors of operation,and the workload of the uninvestigated projects was introduced,and the relative value of human capital input in medical service was constructed.The paired t-test was used to compare the relative value in this study with the US fee schedule,and further verified the hypothesis.The third stage was an empirical research.The DEA method was used to evaluate the economic benefits before and after the reform of the pilot hospital,so as to evaluate the practicability of the RBRVs index system.Results:551 questionnaires were issued,331 questionnaires were recovered,and the recovery rate was 58.26%.Delphi expert opinion reached the same conclusion in the first round.All the secondary indexes in the questionnaire were more than 90%identical.Based on this indicator system,the relative value of 238 pediatric medical projects was calculated,and the extrapolated multiple regression model showed that the operation workload was related to technical difficulty,surgical classification and time of operation,R2=0.699.The paired t-test results showed that t =-1.274,P =0.211,indicating that there was no statistical difference between the results of this survey and the US fee schedule.In the pilot hospital department occupational risk assessment results,the highest risk is the PICU,orthopaedic emergency,the lowest is dermatology clinic,rehabilitation clinic,etc.,which was consistent with the previous quantitative research results.The DEA results showed that the efficiency of human resources continues to increase,and the slack of medical income is significantly reduced,so that the salary reform could be considered to improve the working enthusiasm of medical staff.Conclusion:The RBRVs index system constructed in this study is suitable for measuring the workload of pediatric medical services in China.The pediatrician's input should be measured in five dimensions:total work,occupational hazard,patients'age,working time and physician title.The medical service workload of preschool children is larger,which suggest that the medical project should be priced to consider the patient's age.The occupational hazard score can adjust the bonus distribution in the department appropriately,which can be used for reference in developing countries without perfect medical liability insurance.