Effect Evaluation And Optimization Strategy Of Compensation Mechanism Reform In County-level Public Hospitals In Z City

Objective: To analyze the effect of compensation mechanism reform in county-level public hospitals in Z city,and to clarify the mechanism that affects the effectiveness of reform.To explore the problems existing in the reform of compensation mechanism in Z city and to propose policy proposals for reforming existing problems.Method: Collecting domestic and foreign literature research materials on compensation mechanism reform through literature retrieval,combing the relevant concepts and theoretical basis,based on the “structure-process-result” model,the theoretical analysis framework of compensation mechanism reform is constructed,and the impact mechanism analysis is carried out.In order to make clear the actual implementation situation and effect of the policies of Z city and county public hospitals after the reform,relevant data before and after the reform of compensation mechanism in county-level public hospitals were extracted from the health and family planning information systems of H province and Z city from 2007 to 2018 respectively,and were compared and analyzed.The method of ITS is applied to evaluate the real effect of the reform of compensation mechanism in county-level public hospitals in Z city.Result: By comparison,after the reform of the compensation mechanism,the county-level public hospitals in Z city have made certain achievements in optimizing the medical income,average hospitalization expenses,balance rate of income and expenditure and proportion of personnel expenditure.However,other indicators such as the changes of medical service income proportion,medicine proportion,examination and test income proportion are failed to reach the overall level of H province.The results of ITS show that the short-term effect of the proportion of medical service income after the reform is significant,with the policy implementation year increasing by 4.096 percentage points(P=0.004);Reform of compensation mechanism in Z city has significantly reduced the proportion of drugs.It has decreased by 3.232% every year compared with before the reform(P<0.001).The medical income increased by 78.82551 million yuan per year(P<0.001)compared with that before the reform.The proportion of personnel expenditure has been increased by 2.519%(P=0.006)every year compared with that before the reform.Other indicators are not statistically significant.Conclusion: Z city's county-level public hospitals make some achievements after the reform.It reverses the continued growth trend of increase in the proportion of drugs,improving the operating conditions of hospitals and increasing the labor value of medical personnel.However,there still exist some problems such as the adjustment of medical service price to be improved and the inadequate control of medical expenses and so on.Finally,combined with Sanming's successful experience,it puts forward some policy suggestions to fulfill the responsibility of government investment,improve the price system of medical services,and continue to reduce the medical expenses of patients.Figure 25;Table 10;Reference 82...