| BackgroundHealth is the common pursuit of the people.As the economy continues to grow,the public’s demand for health have increased and brought about the continuous and rapid growth of the total health costs,which not only brings great pressure to the government and society,but also put a heavy burden on the individuals.Although the government has issued a series of policies to control the unreasonable growth of health costs,the problem of heavy medical burden still exists.Using "SHA2011" to carry out cost accounting can well reflect the flow law of health funds and the tendency of health policy making.As an important part of China’s health service system,TCM medical institutions play a key role in maintaining people’s health and promoting health equity.However,there are still some problems that need to be solved in TCM medical institutions in Shandong Province,such as unreasonable structure of supply and demand of health services.To carry out the research on TCM treatment cost accounting and understand the current situation of TCM treatment cost in TCM medical institutions in Shandong province is helpful to master the allocation of TCM health resources and promote the high-quality development of TCM cause and industry.ObjectivesThis study intends to take the treatment service cost of TCM medical institutions in Shandong Province as the entry point.Based on the principles and methods of "SHA2011"health expense accounting system,the scale,raising,distribution and utilization status of treatment costs of TCM medical institutions in Shandong Province were deeply understood from the aspects of total amount,functional distribution,beneficiary groups,financing schemes and cross dimensions.To identify the diseases that need to be prevented and treated,the groups that need to be intervened,and reflect the medical burden of the population;At the same time,it provides policy suggestions for promoting TCM medical institutions to accurately control fees and clarifying the focus and inclination of TCM health investment in Shandong province in the future.MethodsThe data of this study were from the project "Health Cost Accounting analysis of TCM institutions in Shandong Province based on SHA2011" undertaken by the Medical Service Management Center of Shandong Health Committee.Through extensive literature reading and policy analysis,this study fully understands the background and relevant theoretical knowledge of the current treatment cost accounting in TCM medical institutions.Combined with the theoretical framework of "SHA2011",multi-stage stratified sampling method was adopted to determine sample institutions for field investigation and obtain corresponding data.Excel 2016,Stata14.0,SPSS22.0 and other tools were used to collate the data,and "SHA2011" health expense accounting me was used to analyze the treatment cost of TCM medical institutions in Shandong Province from the aspects of financing sources,health service functions,beneficiaries and so on.ResultsIn 2019,the total cost of TCM medical institutions in Shandong province was 28.2106813 billion yuan.(1)From the hierarchical distribution,the treatment cost was mainly concentrated in provincial(32.09%)and county-level TCM medical institutions(37.24%);(2)From the perspective of service function,outpatient cost was 9.0432969 billion yuan,accounted for 32.06%,and hospitalization expenses was 19.1673844 billion yuan,accounted for 67.94%,which were relatively large.(3)From the perspective of beneficiary groups,the treatment costs of 60-64 years old and 65-69 years old accounted for the highest proportion(10.43%and 11.33%,respectively),and the treatment costs of the 65 years and older age groups showed a trend of decreasing with the increase of age.Considering that the sample numbers of different age groups accounted for different proportions of the total sample numbers,the number of treatment service costs of different age groups may be related to the number of people,so further research is still needed to draw specific conclusions.(4)From the perspective of disease distribution,the top five medical expenses of TCM institutions in Shandong province in 2019 were circulatory system diseases,injury,poisoning and some other consequences of external causes,symptoms,signs and clinical and laboratory abnormalities,musculoskeletal muscle and connective tissue diseases,and respiratory disorders.The cost of treatment for these diseases was 21.32%,9.81%,9.70%,9.58%and 8.26%,respectively.(5)From the perspective of financing sources,the public financing scheme was 17.7465626 billion yuan,accounted for 62.91%;the voluntary financing scheme was 2.1361234 billion yuan,accounted for 7.57%;the family health expenditure scheme was 8.327996 billion yuan,accounted for 29.52%;(6)from the point of age and disease cross dimension,the crowd disease with its pathological physiology characteristic,all ages 0-14 year old because the risk is higher,treatment costs are mainly composed of the respiratory system disease,the treatment cost distribution of 60 years of age and older mainly circulatory system disease,respiratory disease and chronic non-communicable diseases such as tumor mainly;(7)From the cross analysis of age and financing dimensions,People aged 60 to 74 had the highest percentage of public funding systems(21.31%),and people aged 60-74 had the highest proportion of voluntary financing schemes(2.63%).Family health expenditure was mainly concentrated in people aged 45 and above,accounted for 17.06%of treatment expenditure.(8)From the cross analysis of disease and financing dimensions,circulatory diseases had the highest share of financing options,injury,poisoning and some other consequences of external causes voluntary financing programs(0.93%)and household health expenditures(5.43%)also accounted for the highest proportion.ConclusionThe results showed that:(1)The growth rate of treatment cost was too fast and the direction of treatment cost was not reasonable;(2)The financing structure of treatment service fee was unreasonable and the financing channel was relatively single;(3)The burden of treating some diseases and people’s medical care was heavy,and cost control needs to be strengthened;(4)The information standard of some medical institutions was low,and it was difficult to obtain specific data of TCM.(5)TCM features appear,but its advantages were not significant.SuggestionsTherefore,the following proposals are made:(1)reasonably control the rapid growth of TCM treatment service cost and the direction of cost flow;(2)Optimize the financing structure of treatment expenses and rationally control family health expenditure;(3)Strengthen prevention and intervention for major diseases and diseases affecting key groups to reduce the burden on the masses;(4)Improve the information level of TCM medical institutions and improve the accounting method of TCM health cost;(5)Strengthen the construction of TCM health services and maximizing the benefits of TCM in Shandong Province... |
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