The Effect Of Abolishing The Policy Of Relying On Medicine To Support Medical Care On Patients’ Expenses

In 2007,the Blue Book Of China’s Society:Analysis and Forecast of Society of China showed that the first social problem in China is that seeing a doctor is both hard and expensive."In recent ten years,the growth rate of per capita medical and health expenditure has already exceeded that of per capita GDP.Under the established medical security system,people’s voice for which is both difficult and expensive to see a doctor is higher and higher.City D is no exception.Based on the in-depth analysis of the existing data of municipal hospitals in D City,the average proportion of hospital revenue from drugs is as high as nearly 35%.It can be seen that the total medical expenses of patients tend to be higher.To a large extent,this reality stems from the higher drug profits,that is,the excessive dependence of hospital income on drug profits,that is,the mechanism of relying on drugs to support medical care.Therefore,reasonable improvement of the income structure of the hospital and ultimately reducing the expenses of patients have become the primary focus of the reform.The abolition of the policy of relying on medicine to support medical service came into being.In 2009,the State Council first proposed to gradually promote the reform process of separation of medicine and medicine,and then steadily carried out comprehensive reform throughout the country.From the selection of county-level hospital reform pilot in 2012 to the abolition of drug-based medical support mechanism in national public hospitals in 2017,the mechanism of drug-based medical support formed since 1954 was officially broken.In terms of city D,the first batch of county(city)pilot hospitals were selected in 2012.In 2015,county-level public hospitals fully implemented the policy of abolishing drug-based medical care.From August 26,2017,city public hospitals in city D fully implemented the policy of abolishing drug-based medical care.After the implementation of the policy,the changes of patients’ total expenses and expenses composition have become the focus of the people and the government.The innovation of this paper is to explain the impact of policy on patient’s expenses from two perspectives:one is to use the average value of hospital data to study the overall expenses change of patients,to reflect the overall average effect of policy implementation;the other is to analyze the individual expenses change of patients based on the time point settlement data of patients,reflecting the individual level effect of policy implementation.At the same time,we further consider the differences in the composition of expenses.Finally,we combine the overall perspective with the individual perspective to confirm the overlapping parts,and comprehensively evaluate the impact of drug-based medical policy on patient expensess.Based on the perspective of the overall expenses of patients,this paper concludes that the average expenses per visit of patients in the pilot hospitals of D city is significantly positively affected by the policy,in which the average expenses of inpatients is negatively affected,and the average expenses of outpatient patients is significantly positively affected.To further explore the change of the composition of the expenses,the average drug expenses was significantly negative,the average medical service fee and examination fee were significantly positive,while the average material expenses was not significant.The results showed that the overall expenses of inpatients was basically consistent with the policy expectation.The average drug expenses and health material expenses decreased significantly,the average medical service fee increased significantly,but the average examination fee increased significantly,which was contrary to the policy.Based on the individual expenses of patients,the total expenses of inpatients was negatively affected by the policy.The difference of inpatients with different diseases was significantly negatively affected by the policy,while the total expenses of inpatients with circulatory system diseases and digestive system diseases was not significantly affected by the characteristics of diseases The difference in policy implementation brought about by this will offset each other among the expenses components.Further analysis of the changes in the detailed expenses,from the perspective of the changes in the composition of inpatients’ expenses,there is almost no difference in the changes of drug fees regulated by the policies among different diseases,that is,the drug fees borne by patients are significantly reduced;the medical service fees are significantly increased except for patients with circulatory system diseases.However,the items that are not regulated by the policy,i.e.examination,treatment and laboratory test,are quite different among different diseases.This is because hospitals have the right to selectively find items to make up for the huge loss of drug profits.Finally,the other expenses mainly including the expenses of health consumables were significantly reduced in patients with the four major diseases,which basically met the policy expectations.Based on the above empirical results,this paper provides the following suggestions for the follow-up reform:first,to control the reasonable range of drug fee adjustment and other expenses(except drug fees)according to different diseases;second,improve the DRGs medical insurance payment policy and consolidate the policy effect;third,improve the fine management of medical service price;fourth,government departments should still formulate measures to adjust to local conditions;Fifthly,we should improve the management plan of the hospital and lay a foundation for the reform from the inside of the hospital.Due to the serious lack of indicators reflecting the individual characteristics of patients in outpatient data,and the lack of basis for studying the impact of policies on individual expenses of outpatient patients,this paper failed to study the impact of canceling the policy of relying on drugs to support medical care on the individual expenses of outpatients.Among them,the main indicators such as ICD code are not filled in,and problems such as wrong filling and random filling of ICD code appear frequently.After the hospital strengthens the training of relevant personnel in business and ethics and corrects the relevant problems properly,it can be further discussed in future research.