Study On Cost Control Of Single Disease Based On Traditional Chinese Medicine Clinical Pathway:

BackgroundRecently,benefited by the development and expansion of medical security system in China,more than 90%of the population could be covered by basic medical insurance when they need.However,it brought heavy pressure and high requirements for the management of health insurance funds,especially with the rapid growth of medical cost due to medical techniques progress and growing medical demand of the population.To deal with these challenges,reform of medical insurance payment methods was implemented.Single disease payment set expense ceilings for single diseases and refuses to pay hospitals for expense overruns.In this case,hospitals have to manage to regulate medical behaviors and optimize treatment processes through the implementation of clinical pathways,which could definitely help hospitals improve their management level while easing the financial burden of patients and health insurance funds.Thus,in order to cope with single disease payment reform,S hospital aims to achieve the goals of cost control and quality improvement by building and implementing a traditional Chinese medicine(TCM)clinical pathway for lower extremity varicose veins.ObjectiveThe study aims to build a clinical guide for lower extremity varicose veins with therapeutic schedule and expense regulations through the integration of clinical pathway and single disease payment standard,and analyze issues exist during treatment processes based on the results of retrospectively contrastive analysis between patients' medical expenses and clinical guide.This study tries to find out reasons that give rise to high medical expenses from patients characteristics,treatment programs and procedures,and hopefully provide some references for further improvement of implementation of single disease payment and TCM clinical pathway.MethodsQualitative and quantitative analysis were used in this study.For qualitative analysis,5 professionals,including doctors,nurses and anesthetist,were interviewed so as to formulate the expense control standard integrated with clinical pathway for lower extremity varicose veins,analyze problems exist during patients treatment and provide some suggestions for further improvement.For quantitative anallysis,statistical description,chi square test,t test,rank sum test and binary logistic regression were widely used in the study.Specifically,chi square test and rank sum test was used to analyze the difference in patients characteristics between patients whose expense above and below the ceiling;binary logistic regression was used to further analyze the influence factors of medical expense.When it came to the contrastive analysis between medical expense/length of stay and expense control standard integrated with clinical pathway,t test and rank sum test were adopted on account of data distribution.Results(1)Through the multivariate analysis of medical expense,this study found that length of stay(LOS)and treatment effect could affect medical expense.Both of them are risk factors of medical expense.ORLos=2.081,for each additional day of hospital stay,patients were 1.081 times more likely to overspend on medical expenses;ORtreatment effect=3.237,medical expense of patients who were recovered are 3.237 times of that of patients who only got improved.(2)By analyzing the medical expense above single disease payment standard,the study found that western medicine(3730.02 yuan)was the most expensive part among those expenses,followed by operation fee(2450.00 yuan).However,when contrasted with expense standard,it showed that western medicine is the main factor that caused high medical expense while operation fee is lower than the standard.(3)Through contrastive analysis between medical expenses and expense standards in different processes,it came out that preoperative preparation,operation and postoperative recovery are processes that exist cost overruns,especially the postoperative recovery process.Cost overruns in postoperative recovery process could be explained by long length of stay and high western medicine expense.Conclusions and SuggestionsThis study found that postoperative recovery process can explain most expense overruns in patients medical expense.More specifically,there are mainly 3 problems causing expense overruns:long length of stay,high western medicine expense and process expense transfer due to non-standard operation.Therefore,4 suggestions are recommended based on this study:(1)Minimally invasive surgery and ambulatory surgery should be generalized in order to reduce patients length of stay,especially in postoperative recovery process,and also reduce medical expense;(2)Revenue structure should be optimized continuously,and expense of western medicine should be monitored and regulated;(3)Give full play to the special expertise of traditional Chinese medicine and highlight its therapeutic effects and price advantages;(4)Standardize treatment and charging behavior,eliminate unreasonable transfer of process expenses.