Research On Compensation Mechanism Of Public Hospitals In Shandong Province Based On System Dynamics

BackgroundIn the process of development,public hospitals faced with such problems as insufficient financial investment,inadequate adjustment of medical service prices,increasing medical expenses of the masses,and "supporting doctors with drugs"becoming a more and more serious problem.The new medical reform came into being in 2009,aimed at eliminating various malpractices in the medical and health industry and constructed a medical and health service system that suitable for China's national conditions.In line with the spirit of the national and Shandong health reform,public hospital reform of Shandong Province required all public hospitals participatir,in the reform before the end of June 2016 to cancel the drug additions and rationally adjusted the price of medical services,strictly controlled irrational inspection and chemical examination costs.Health policy makers focus on the problems of what is the status quo of compensation;what are the problems;how to solve the problems.The System Dynamics method designs alternative schemes by constructing model simulation and Scenario analysis of compensation policy,to provide scientific evidence for decision makers.Although this method has been applied in the field of medical and health care,it was rarely applied in the research of compensation mechanisms in provincial public hospitals.Therefore,this paper can meet the needs of current health policy and make academic contributions in methodology.ObjectiveThis study analyzed the current situation and existing problems ofcompensation mechanism reform in public hospitals in Shandong Province.Weconducted Scenario analysis using System Dynamics Method on financialsubsidy income and medical service income in the compensation mechanism,so as to provide specific options for improving the compensation mechanism reform policy.MethodsThis study used literature research method to collect domestic and foreign literatures on the compensation mechanism of public hospitals.Applied the theory and method of System Dynamics and used VENSIM software to draw causality diagram and system flow diagram and to construct a concrete model of the compensation mechanism of public hospitals in Shandong province,determined the main variables and parameter settings of the model and tested the fit of the model.We put forward some solutions of the problem through policy simulation and Scenario analysis.Key person interview method was used to summarize and analyze the current financial status of public hospitals and draw the specific suggestions.The experts included health policy managers,medical reform policy makers and hospital administrators.Results1 Compensation status and problems of public hospitals in Shandong provinceFrom 2012-2017,the financial subsidy income of public hospitals has increased.The proportion of medical services including the income of bed,nursing,surgery,treatment,etc.has increased.The proportion of medicines income including the western medicines and proprietary Chinese medicines showed a downward trend,and the proportion of Chinese herbal medicines grew.The growth rate of inspection,laboratory test and sanitary materials declined significantly.Existing problems:low proportion of financial subsidy income,serious loss of medical services,the proportion of medicines has not reached the expected target,the inspection and testing and health materials accounted for a relatively high proportion.2 System simulation of compensation mechanism in public hospitalsIf we continued to implement the drug addition policy,we found that the proportion of financial subsidy income in public hospitals was very low,and the public welfare of hospitals was difficult to be guaranteed.By simulating the compensation policy of public hospitals,it was found that the total expenditure of the hospital was greater than the total income,and the hospital was in the state of loss.3 Scenario analysis of compensation policies for public hospitalsScenario analysis of individual compensation policy:Analyzed of the impact of growth rate of financial subsidy and medical service on the balance of income and expenditure of public hospitals,we found that public hospitals can maintain balance when the financial subsidy growth rate reached 70%.Public hospitals can maintain a surplus when the price of treatment and surgery increases by 22%each.If we increased the growth rate of treatment and surgery,when the growth rate reached 22%,public hospitals would be completely in a state of balance.Scenario analysis of comprehensive compensation policies:The growth rate of financial subsidies,treatment and surgery medical service were combined to analyze,there would be seven different combination plans,when the growth rate of financial subsidy was 25%,treatment and surgery medical service were 16%respectively,and the public hospitals could maintain their operation and development.Conclusions and SuggestionsAchievements in the reform of the compensation mechanism of public hospitals in Shandong Province:First,the proportion of pharmaceutical income has dropped significantly,and staged results have been achieved.Second,the total income of medical services and the proportion of income of various service items increased,the reform effect began to appear.At the same time,there were also many problems:First,the proportion of government financial subsidies was low.Second,the balance of medical service has been in a loss state and becoming more and more serious.Third,the structure of medical income was unreasonable,the proportion of the inspection and test income and health materials income were higher than surgical income,and the value of medical personnel was not fully reflected.Based on the above conclusions,the suggestions of this study were as follows:First,reasonably formulate financial subsidy standards and increase financial special subsidies.Second,further increase the price of medical services and establish a dynamic adjustment mechanism for the price of medical services.Third,optimize the structure of medical income and continue to reduce the proportion of inspections and laboratory tests.