| BackgroundIn order to address the problem of the common people to see a doctor in difficulty,the government began to reform the compensation mechanism of public hospitals.In May 2015.The document points out that public hospitals in all pilot cities should promote the separation of medicine and eliminate the mechanism of supplementing medicine with medicine.In addition to the decoction of traditional Chinese medicine,all medicines should be cancelled the drug mark up,increasing government investment,reforming the way of payment,and reducing the cost of hospital operation,a scientific and reasonable compensation mechanism was established.In October 2015,Dongying City promulgated the pilot implementation plan for comprehensively deepening the comprehensive reform of public hospitals in Dongying City,which stipulates that the city’s public hospitals above the second level shall fully implement the zero margin sales of drugs,establish a scientific and reasonable compensation mechanism through adjusting the price of medical services,increasing government investment,reforming the payment method of medical insurance,strengthening the accounting of hospitals,reducing the operating cost,etc.,marking the opening of The reform of compensation mechanism of public hospitals in qidongying city was carried out in an all-round way.In the past three years after the reform of compensation mechanism in Dongying City,how has the compensation situation of public hospitals changed?What is the impact on hospital economic operation?All of them are concerned by hospital managers and health policy makersObjectiveThe overall goal of this study is to find out the problems in the reform and provide scientific evidence for the further development of the city’s public hospitals by analyzing the measures and effects of the reform of the compensation mechanism of the second and third level general public hospitals in Dongying City.The specific purpose is as follows:(1)To find the achievements and deficiencies of the reform in the compensation mechanism.(2)To explore the effects of the reform on the economic operation of dongying comprehensive public hospitals of different levels.(3)According to the compensation situation of the compensation mechanism reform in Dongying City and the analysis of the impact on the economic operation of the hospital,this paper provides reference suggestions for deepening the compensation mechanism of public hospitals.Contents1.Describe the change of compensation status of dongying city second-and third-level comprehensive public hospitalsThis paper analyzes the compensation mechanism of the second and third level general public hospitals in Dongying City from the aspects of financial compensation and medical business income compensation,and focuses on the compensation of medical service income in the aspect of medical business income compensation.2.Analyze the impact of compensation mechanism reform on the economic operation of dongying city’s second-and third-level comprehensive public hospitals In Dongying City from five dimensions:medical expense control,cost management,asset operation,work efficiency and development ability.3.Put forward Suggestions on the problems existing in the compensation mechanism reform of dongying city second-and third-level comprehensive public hospitals Based on the analysis of the compensation situation of Dongying second were conducted to put forward suggestions for improvement of the problems existing in the reform.SourceThe data of this study mainly come from the national,Shandong and Dongying medical reform policy documents,domestic and foreign literature on the reform of public hospital compensation mechanism and hospital economic operation;The system of public hospitals in 2015 and the existing statistical indicators in the health statistics platform system of Shandong Province;The data is from the health statistics of Dongying City from 2008 to 2018,specifically from the health statistics platform system of Shandong Province.Study designThe analysis of interval time series method was used to study the economic operation of Dongying second-and third-level comprehensive public hospitals.2015,when the compensation mechanism was fully implemented in dongying city,was used as the intervention time point,and the time interval was measured in years.2008 to 2014 was used as the pre-intervention time point,and 2016 to 2018 was used as the post-intervention time point.Method(1)structural analysis methodThe dimension of medical business compensation and cost management adopts the structural analysis method to analyze the proportion of drug revenue,technical service revenue,health materials,inspection and test revenue to the total medical revenue,and the proportion of drug expenditure,personnel expenditure,health materials,inspection and test expenditure to the total expenditure.Reflect the proportion of specific items in income and expenditure.(2)ratio analysisThe dimension of cost management ability,the rate analysis method is used to analyze the economic operation of the hospital.Results(1)Implementation status of compensation mechanismThe government’s financial subsidies are not in place.After the reform of the compensation mechanism,the proportion of the financial subsidy revenue and the financial subsidy revenue to the total revenue of Dongying public general hospitals in 2016-2018 shows an overall downward trend.In terms of medical business income,the medical business income of Dongying secondary public general hospital decreased in 2018,and the corresponding proportion of medical business income to total hospital income also decreased.The structure of medical income was optimized.After the reform of the compensation mechanism,the proportion of drug income in the secondary public general hospital of Dongying City showed a downward trend(β1+β3<0),with a long-term effect(P<0.05).After the reform of the compensation mechanism,the proportion of secondary drugs in Dongying City decreased significantly.After the reform of the compensation mechanism,the proportion of technical labor income in the secondary and tertiary public general hospital of Dongying City showed a downward trend before the reform of the compensation mechanism(β1<0),after the reform,the rising trend(β1+β3>0)has long-term effect(P<0.05),after the reform of compensation mechanism,the proportion of technical labor income of Dongying Level 2 and level 3 has a significant effect;after the reform,the proportion of inspection acceptance of Dongying Level 2 and level 3 public general hospitals has a rising trend,but the rising range is smaller than before(β1+β3>0,β 3<0),Only the long-term effect was significant(P<0.05)after the intervention of Dongying three-level reform,which indicated that the income of Dongying three-level inspection and test increased significantly after the reform of compensation mechanism.(2)A brief analysis of the impact of compensation mechanism reform on hospital economic operationControl of medical expenses:the average outpatient expenses of the second and third level public general hospitals in Dongying City increased slightly after the reform of compensation mechanism,but still increased(β3<0,β1+β3>0),the average hospitalization expenses decreased after the reform(β1+β3<0),only the third level had long-term effect(P<0.05)Cost management:after the reform,the cost rate of secondary medical income in Dongying showed a downward trend(β1+β3<0),but it still showed an upward trend after the reform,which was slower than before(β1+β3>0),and there was no long-term effect after the reform(P>0.05).After the reform of Dongying tertiary public hospital,it showed an upward trend(β1+β3<0),with long-term effect and immediate effect(P<0.05),which indicated that after the reform of compensation mechanism,the proportion of the staff expenditure occupied by the 100 yuan medical income of Dongying tertiary public hospital increased significantlyAsset operation:the development trend of the indicators of total asset turnover rate,current asset turnover rate and fixed asset turnover rate of the second and third level public general hospitals in Dongying City is completely opposite.After the reform of total assets turnover rate and current assets turnover rate in Dongying secondary public general hospital,there was a downward trend(β1+β3<0),and the decline had a long-term effect,which was statistically significant(P<0.05),indicating that after the implementation of the reform of compensation mechanism,Dongying secondary public general hospital had a lack of effect in the operation of total assets and current assets;after the reform of fixed assets turnover rate in Dongying,there was a downward trend(β1+β3<0)The downward trend(β1+β3<0)was statistically significant and had a long-term effect(P<0.05),which indicated that the effect of Dongying third level public general hospital in fixed assets operation was insufficient after the implementation of compensation mechanism reform.Working efficiency:after the reform,the number of bed turnover in Dongying secondary public general hospital showed an upward trend(β1>0,β1+β3>0),which was statistically significant(P<0.05),with long-term effect.The results show that after the implementation of the compensation mechanism reform,the number of hospital bed turnover in Dongying secondary public general hospital is significantly improved.After the reform,the average length of stay of discharged patients in Dongying secondary public general hospital showed a downward trend(β1<0,β1+β3<0),which was statistically significant(P<0.05),and had a long-term effect.The results show that after the implementation of the compensation mechanism reform,the average length of stay of discharged patients in Dongying secondary public general hospital is significantly reducedPublic general hospitals have no long-term effect and have no statistical significance(P>0.05)Conclusions and suggestionsAccording to the analysis of the current situation of the reform of the second and third level public comprehensive compensation mechanism of the reform of the compensation mechanism in the second and third level public general hospitals in Dongying City are as follows:First,the income structure has been optimized,the proportion of drug income meets the policy requirements,and the rising trend of the proportion of technical labor income is consistent with the policy guidance.Second,the control of medical expenses has some effect.After the reform of the second and third level general hospitals in Dongying City,the overall upward trend slowed down obviously.Third,cost management has achieved certain results.In 2018,the proportion of health materials occupied by the 100 yuan medical income of Dongying public general hospital was 13.13%and 19.95%respectively,which were lower than 20%.Fourth,the work efficiency has been improved significantly.At the same time,there are some problems in the economic operation of Dongying public hospitalsFirst,the proportion of health material income and inspection and test income in the income structure is on the rise after the reform,which is inconsistent with the reform policy guidance.All of them are not in line with the policy guidance of "some opinions on controlling the unreasonable growth of medical expenses in public hospitals" in 2015,which points out that the proportion of health material income and examination and test income to medical income should be gradually reduced.Second,the ability of cost management is weak,and the cost rate of medical income is rising.After the reform,third level public general hospitals in Dongying City showed an overall upward trend.It is contrary to the policy guidance the management expense rate should be gradually reduced.Third,public general hospitals in Dongying City all showed a downward trend after the reform.Based on the above conclusions,the following suggestions are put forward for health policy makers and hospital managers:1.Strengthen government financial subsidies and innovate financial compensation programs2.Enhance the management and control of health materials,inspection and testing,and optimize the structure of income and expenditure3.Reinforce the internal management of the hospital,and reduce the management cost rate4.Strengthen the management of current assets and fixed assets,and improve the ability of asset operation5.Try to improve the medical technology and service quality of hospital doctors,so as to improve the overall medical level of the hospital... |
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