Impact Of Case-based Payment On Medical Quality Of County Level Hospitals

[Purpose] On the basis of literature analysis and field research,using qualitative and quantitative analysis method,evaluated the quality of health servise before and after the case-based payment reform,explored the influence on health service quality affected by case-based payment,and provided decision basis for perfecting payment reform.[Methods] Chose bronchopneumonia as the target disease,chose 2013 in wich case-based payment was carried out as time node,chose dangyang which is affected by payment reform as the treatment point,and zhijiang as a control point to carry out the investigation and compare the single disease quality changes in these two county from 2012 to 2014.Collected reports,policy documents and data records from NCMS,and extracted medical records from the People's Hospital.after screening,we chose 386 patient as the research sample.Use descriptive statistical analysis to describe the basic social and economic information,as well as the quality evaluation index,and evaluated case-based payment effects on medical quality by DID model.[Results](1)The rate of admission criteria adherence in target group improved to 81.11% in 2014,while the change of the corresponding period of control group was not significant in statistic.The rate of cases meet 3 of the discharge significantly improved in both target group and control group,and variation amplitude in target group is greater.(2)Each case of target group accepted 8.26,8.29 kinds of auxiliary examination on average in 2012 and 2014.The examination carried was generally associated with the treatment of bronchopneumonia.The frequency of examinations necessary to be carry out increased,while that of examinations chosen according to situation decreased.(3)The first dose administration was accepted about 1 hour after admission in the treatment group,and half hour after admission in the control group on average.The rate of recovery within 72 hours in target group in 2014 statistically increased 19.59 percentage point to 93.55%,which was higher than in the control group.(4)The rate of rescribed discharge or referral in target group held at 90%.The total medical expenses and drug expenses significantly decreased in target group,while significantly increased in control group.Medical fee of 87.32% of the cases reimbursed through case-based payment was within the ration standards.the hospital shoud pay 64.11 yuan per patients above proof on average.(5)Case-based payment can help to improve admission criteria adherence,improvement within 72 hours,while have no significant effect on the rate of antibiotics accepted within 4 hours after admission,antibiotics combination and antibacterials course.Case-based payment can help to increase Prescribed discharge or referral,reduce hospitalization expenses,while had nothing to do with hospital stay[Conclusions] Case-based payment can help improve standardability of admission and discharge,improve the efficiency and effectiveness of clinical treatment,reduce medical expense,improve the ratio of prescribed discharge or referral,to help improving patient satisfaction.Overall,the case-based payment has a positive impact on medical quality.However,case-based payment's function as an economic lever is limited,and we still need the improvement of medical staff and medical technology to improve medical quality.