Research On The Impact Evaluation Of Comprehensive Reform Of County-level Public Hospitals

[Purpose] Based on the overall situation of the comprehensive reform of county-level public hospitals in Hubei province,this study grasped the basic conditions relating to health resources,health care,medical services,health input and information construction in two reform pilot areas,as well as compensation mechanism,medicare payment reform,income distribution system,hospital management and service capability and other aspects of implementation situations.Then we understood pilot county hospitals' operation and policy effects preliminary from the three dimensions of financial condition,human resources and service ability status,in view of the transverse and longitudinal descriptive comparative analysis and ?2 test about the changes of indexes from 2011 to 2013.In addition,this research established the evaluation index system including the five dimensions of economic operation,medical quality,service efficiency,cost control and medical expenses referring to county public hospital reform effectiveness,considering the policy file as well as the correlation of reform measures and hospital's operation.Meanwhile,Dual difference model(DID)was used to analyze the operation indicators and influence of the comprehensive reform of county-level public hospitals from the micro level.Finally,a detailed analysis witnessed the effect mechanism of the reform measures,and around the reform contents,improvement path and suggestions of further reform provide the reference for decision-making and practice.[Methods]In this study,we chose 35 comprehensive hospitals participating in the first batch and the second batch of reform pilot as our objects.Data mainly came from the following sources: Hubei provincial Health Statistics Yearbook;progress monitoring system of comprehensive reform;field investigation.Having some acquaintance with the basic situation and reform progress in the pilot areas,this study firstly compared to the two batch of pilot county hospitals from 2011 to 2013 about related operation indicators to determine a statistically difference by using descriptive statistics and Kruskal-Wallis H Test;secondly,it established the evaluation index system as to reform effectiveness via literature optimization,clustering analysis and qualitative consultation;finally,double difference model(DID)hinted at generated policy effectiveness degree on the index(micro)level;in addition,the relevant personnel of the health system and the hospitals all adopted the qualitative research methods of interview.[Results](1)In 2013,the first batch of pilot county hospitals have all canceled drug markup.And about compensation channels,reasonable adjustments of the medical service price bear compensation rate of 71.19%,coupled with an increase of government investment accounting for the highest proportion of 16.70%.In 2014,the quantity reached 50 referring to DRGs of New Rural Cooperative Medical(NRCM)in the tertiary hospitals;the implementation proportion was more than 80% about the personnel system and income distribution system reform in the first pilot hospitals;slow progress in the hospital management system reform;the first batch of pilot hospitals have basically achieved instant calculation.The number of diseases and cases that implemented clinical pathway respectively reached 61.95 and 3312.83.(2)From 2011 to 2013,growth in total income,medical income and funds of the first batch of pilot hospitals was significant,with an average annual growth rate of 22.50%,34.45% and 22.39% as well as statistical difference(P < 0.05).Drug rates fell by an average of 64.17%,and the proportion decreased from 36.90% to 30.81% three years.The revenue proportion generated in medical services projects reflecting the labor value of medical personnel increased significantly compared to that before the reform,but it went by contraries when involving equipment examinations,laboratory tests and health materials.Asset liability ratio was within the controllable range;The total fixed assets of second pilot hospitals increased to a certain extent,with an increase of 10.44%.Drug proportion got the basic balance of 34% in the past three years.From 2011 to 2013,the total occupied bed days of the first pilot hospitals increased significantly,and the difference was significant.Compared to the second pilot hospitals,the average cost slowed.The drug proportion of outpatients and inpatients in two pilot hospitals decreased respectively.Bed turnover and average hospitalization days of the pilot hospitals all witnessed negative changes,which explained service efficiency reversely.(3)This paper established the evaluation index system of county public hospital reform,which included 5 first level indicators,such as economic operation,medical quality,service efficiency,cost control and medical expenses,and the 20 secondly indicators.(4)The county public hospital comprehensive reform had no significant effect on the economic operation of the pilot hospitals and caused negative effects on the medical quality.After the reform,the utilization efficiency of health resources in the pilot hospitals was effectively improved,and the cost of drugs has been controlled.Policy implementation contributed to-0.12 thousand yuan of the average drug cost.The pilot hospital has made some progress in cost control attributed to drug price rather than quantity and preference,but it had no decrease on the outpatient expenses.[Conclusions](1)Reform measures had inconsistent steps and lacked of top-level design;(2)The comprehensive reform had a limited influence on the overall efficiency of pilot hospitals;(3)Policy measures can positively or negatively affect the efficiency of of pilot hospitals.