| Research background and objectiveWith the advancement of comprehensive reform of urban public hospitals,the comprehensive reform of medical price of urban public hospitals has become an urgent task after completely abolishing the policy of drug addition.Although some provinces(cities)have made some achievements in the practice of medical service price adjustment,there are still some gaps in the price adjustment of medical services in some provincial(cities)public hospitals in the loss of abolishing the drug bonus.Since 2015,a city in Ningxia Hui Autonomous region has implemented a policy of abolishing drug premium rates in municipal public hospitals,including the Grade 3A public hospital,and has introduced a 6:3:1 compensation policy,but after the implementation of the compensation policy.Related research found that the drug additive can not fully compensate for the policy losses.By comparing the income and expenditure structure of public hospitals before and after the reform,and the changes of medical services,this paper analyzes the operational effects of abolishing the drug bonus and adjusting the price of medical services in urban public hospitals.Furthermore,the compensation level of medical service price adjustment to the public hospitals in Ningxia is further calculated,which can provide reference for promoting the comprehensive reform of medical prices and optimizing the income structure of urban public hospitals.MethodsQualitative and quantitative statistical analysis was used to compare and analyze the operation of the hospital before and after the reform,and its influencing factors,and to describe and analyze the operational effect of abolishing the drug addition policy in the public hospitals of the city.The contribution rate method was used to analyze the extent of the role of each medical service sub-item in the growth of medical service income.Using system dynamics to construct the system dynamics model of medical service income compensation mechanism,simulate and simulate the out-patient and inpatient medical service income under the non-reform state(drug addition policy)in 2015-2017.Finally,the comprehensive actual compensation rate of medical service income to drug policy loss after the reform in 2017 is calculated.Research results1.Public hospitals in a certain region of Ningxia have abolished the drug bonus and adjusted the price of medical services.(1)the operation of hospitals tends to be stable,the income structure is improved,and the expenditure structure tends to be optimized.First,the public hospitals change from negative income to surplus.Total income increased.After the reform,the balance of income and expenditure in 2015 fell by 90.3 percent from the same period last year,and the balance of income and expenditure was only 0.52 percent.In 2016,there was a shortfall of income over expenditure,and the balance of income and expenditure was-1.36 percent.However,by 2017,public hospitals had changed from negative income to surplus income.The income and expenditure surplus rate reached7.38%,which is the highest in the past years.Second,the proportion of drugs decreased significantly.After abolishing the drug bonus reform,the average drug share of the five municipal public hospitals in Ningxia fell to 27.74 percent,reaching the reform target of less than 30 percent of the drug reform,especially in-patientmedicine,which fell from 49.85 percent in 2009 to 29.6 percent in 2017.Thirdly,the income of medical service items such as nursing,operation,treatment,diagnosis,bed and so on,which reflect the value of medical personnel under fineds technical service,has increased rapidly,and the proportion of medical income has increased.Before the reform,the proportion of technical labor services such as surgery,treatment,and nursing services to medical income has been declining year by year,and the proportion of technical labor income to medical income has increased from 15.87% in2014 to 22.6% in 2017.It was up 6.73 percentage points.In the first year of reform,inspection income fell 10.8 percent from the same period before the reform,the growth rate of laboratory income was significantly lower than that of the previous year,and the structure of medical revenue was further improved.Fourth,after the reform,the overall expenditure structure of public hospitals has been optimized,the proportion of medical operation cost to total expenditure has increased year by year,the proportion of drug expenditure has decreased obviously,and the expenditure of financial subsidy projects has shown an increasing trend year by year.(2)the increasing trend of medical service is affected,and the increase of medical expenses is the increase of medical service year by year,but the rate of increase is lower than that before the reform.Although the number of outpatients and discharged from public hospitals in Ningxia from 2009 to 2017 showed an overall trend of increasing year by year in absolute terms,it was not greatly affected,but in the trend of month-on-month growth rate,both of them began to decline in 2015.2015 out-patient visits fell-0.2% from the same period last year,and only slightly recovered in 2016.Second,the control effect of the average drug cost was obvious,but the average medical cost increased year by year.The average outpatient medical fee was 135.73 yuan in the year before the reform,and only increased 14.19 yuan after the reform.After the reform,the daily average drug cost of inpatients decreasedand decreased year by year.For example,the average daily drug cost of inpatients was255.7 yuan in 2014 and 252 yuan in 2017 after the reform.However,after the reform,the price of medical services was adjusted,the average medical service fee for outpatient services rose from 129.5 yuan to 143.4 yuan,and the average daily medical service fee for hospitalization increased from 440 yuan to 599.4 yuan,resulting in an increase in the average medical expenses for out-patient and in-patient visits.(3)the control effect of outpatient drug proportion is not satisfactory,and health materials have become an important part of medical revenue and expenditure.First,after the reform,the proportion of out-patient medicine is still relatively high.From2009 to 2017,the proportion of Chinese medicine in outpatients undefined total income decreased from 57% to 45.27%.This indicates that drug revenue is still an important source of outpatient revenue.Second,after the reform,the proportion of health materials to medical income and total expenditure increased year by year.Although health materials fell 1.6 percent in the first year of reform compared to the year before the reform,the share of health materials rose from 10.7 percent to 13 percent as the reforms advanced.By analyzing the income of out-patient and in-patient medical services,it is found that the income of health materials has a great influence on the income of inpatient medical treatment.In 2017,the proportion of income of health materials in hospital to the total income of hospitalization reached20.57%.Spending on health materials increased rapidly after the reform,from 13.3percent before the reform to 14.7 percent.In 2017,the expenditure on health materials was 49.068 million yuan,while the income from health materials was34.97 million yuan.After the reform,100 yuan of medical income consumption of health materials showed an upward trend,by 2017 100 yuan of medical income consumption of health materials reached 29.1 yuan.(4)with the advance of the reform,the proportion of examination income andlaboratory examination income did not fall but increased in the structure of outpatient income.In the first year of the reform,the proportion of check-up income in 2015 decreased by 2.72 percentage points compared with 2014,a relatively large decline.However,as the reform advanced,its share rose rapidly to 12.56 percent in 2017,close to the pre-reform share.The share of laboratory income in 2015 fell by 0.26 percentage points in 2014 before the reform,and in 2016,the share of 2017 continued to increase.In 2017,the share was 11.75%,higher than before the reform.In the income structure of hospitalization,in 2015,the proportion of check-up income in2016 was between 7.1% and 7.2%,a significant decrease,but in 2017,the proportion of check-up income rose to 9.74%.In 2009-2014,the percentage of laboratory income was between 6.35 percent and 10.35 percent,showing a continuing upward trend.After the reform,the share of laboratory income rose from 10.38 percent to 11.32 percent in 2015-2017.2.The compensation degree of Policy loss caused by adjusting the Price of Medical Service and the result of Policy experiment(1)the income structure adjustment is not in place,and can not make up for the policy loss caused by abolishing the drug additive rate along with the advancement of the reform.By 2017,health care revenue had continued to grow,up 6.73 percentage points from 2014 for projects dominated by technical services,but at the same time by4.4 percentage points for goods-and-materials-based projects.Although the share of income from material consumption was lower than that from technical labor,in 2017,the share of income from medical treatment accounted for 40 percent and the income from technical labor accounted for 22.6 percent.The system dynamics is used to simulate and simulate the income of out-patient and in-patient medical services from2015 to 2017 under the non-reform state,and the comprehensive actual compensation rate of medical service income to drug policy loss after the reform in 2017 isestimated to be-81.5%.Among them,the compensation rate of technical labor income in medical service income is 80%.The reason is that the proportion of material consumption income is too high,which leads to the price adjustment and compensation is too high,and finally,the medical service income compensation is insufficient.(2)the emphasis of the price adjustment of medical services should be shifted from compensating for the loss of drug bonus to changing the income structure of public hospitals and using the reduced drug revenue of hospitals after the abolition of drug bonus as the basis for price adjustment,that is to say,a supplementary percentage should be added.It is difficult to form a reasonable price system and scientific compensation basis,nor is it possible to fundamentally reverse the situation of public hospitals relying on material consumption income.In 2017,the balance rate of revenue and expenditure of public hospitals belonging to a certain city in Ningxia was 7.38%.It is indicated that the overall operation of the hospital has tended to be stable.In order to improve the actual comprehensive compensation rate of medical service income,the blind adjustment of the medical service price and the increase of the medical service income will lead to the phenomenon of "bottoming out" of the medical insurance fund or the increase of the burden on the masses.Therefore,in the system policy experimental scheme,the focus of medical service price is transferred from the loss of compensation for canceling the drug bonus to adjusting the income structure of medical service.Results of policy experiments: assuming that,close to the actual income from outpatient and in-patient medical services in 2017,the proportion of out-patient technical services income will rise to 25.48%,while the share of material consumption income will decrease to 26.67%.The share of income from in-patient technical services rose to 43%,while the share of income from material consumption dropped to 27.17%.It completely changes the situation that the medicalincome of public hospitals depends on the material consumption income,changes the income structure of the public hospitals,and realizes the optimization of the income structure.RecommendationsThe government should perfect the medical service price system,adjust the medical income structure,scientifically calculate the medical service cost,establish the dynamic medical service price adjustment mechanism,strengthen the supervision of the drug consumables,speed up the reform of the medical insurance payment method and establish a scientific financial compensation mechanism.At the hospital level,we should strengthen the internal meticulous management,reduce the cost of management and operation,strictly control the unreasonable increase of hospital health material cost,inspection fee and laboratory fee,improve the level of medical service charge,strengthen the supervision of health materials;Improve medical quality and technical level;rationally use of drugs,development of clinical pharmaceutical care. |
PDF Full Text Request