Study On Consistency Of Medicare Expense Control And Medical Quality Improvement

Objective:The purpose of this study is to analyze whether the hospitals will actively neglect to promote the medical service quality when using global budget to control the medical expenses,and to explore the ways in which the hospitals change their behavior under the global budget.Through the analysis of changes in medical service volume,medical expenses,fee structure,length of hospital stay,etc.after implementing global budget(2010-2017)in a tertiary hospital in Tianjin city,the impact of medical insurance cost control on the quantity and quality of medical services will be discussed.Methods:The data was collected from the medical insurance and medical record system of a public tertiary hospital in Tianjin city,and the detailed data of the inpatients whose discharge dates were between January 1,2010 and December 31,2017.The indicators can be divided into three major categories:1)General characteristics of inpatients,2)Medicare reimbursement information,3)Hospitalization information,and 4)Details of hospitalization expenses.The ratio of the average cost of hospitalization and the cost of hospitalization was adopted as the index of effect of fee control,and the average length of hospitalization and the proportion of medicines were used as indicators of medical quality.Descriptive statistical analysis and Pearson correlation analysis were used to test the consistency between the cost of medical insurance control and the improvement of medical service quality.Results:1)31191,35523,40703,42116,40448,44254,48992,46113 cases of inpatients in a tertiary hospital in Tianjin city from 2010 to 2017,separately.The average age of inpatients was about 40 years,and the proportion of female patients was slightly higher than that of males.Among them,the proportion of urban residents with medical insurance is the highest,close to 50%,followed by self-paying patients(about 30%)and urban residents medical insurance patients(about 15%).2)Between 2010 and 2017,the cost of hospitalization for patients with different types of medical insurance has increased significantly.The cost of patients of Urban Employees Medical Insurance(UEMI)is consistent with that of Urban Residents Medical Insurance(URMI)and self-paying patients,and the trend of changes in all inpatients.After analysis,urban workers and urban residents have been analyzed.The change trend of the hospitalization expenses for patients with medical insurance and other medical insurance types also showed a high degree of consistency(Pearson r was above 0.95).UEMI and URMI did not show a significant decline in the rate of increase in hospitalization expenses under the total amount prepaid system,and their growth rate was basically consistent with that of other types of inpatients.3)The average number of hospital stays and drug proportion for UEMI,URMI and self-paid patients showed a significant decline from 2010 to 2017,and that of patients of URMI was consistent with that of URMI and self-paid patients,and all the inpatient changes.Even the rate of decline was slightly faster,and there was no significant decline in the number of annual hospitalizations and quarterly hospitalizations among hospitalized residents of urban residents.According to relevant analysis,the trends of the average hospitalization days,the proportion of medicines,and the number of hospital stays among the urban residents and urban residents with medical insurance and other types of medical insurance are highly consistent(Pearson r was above 0.9).Conclusion:The global budget payment system has obvious effects on fees control,but the factors influencing medical expenses and quality are various.Therefore,when seeking measures to control costs and improve quality,comprehensive consideration should also be given to various factors,and the global budget prepayment system design should be improved,strengthen total budget management,and actively explore compound payment methods according to the characteristics of payment methods,actual management capabilities,and the implementation environment.Selection should be made according to specific circumstances,and a balance should be sought between cost control and medical quality.The realization of the macro goals of medical services requires the joint efforts of the government and the whole society.The higher-level medical insurance expense control should be learning the management-type health care insurance model,strengthen disease prevention and management,and control the costs before the occurrence of diseases and improve medical care,improve the current medical service quality and environment.