| ObjectivesThis study is to explore and understand those main problems existing in the price formation mechanism according to the in-depth analysis of the Medical Service Price（MSP）system status in China.The tiered pricing model of medical service is formulated in line with China’s national conditions,and the pricing mechanism of medical services is established and improved base on incentive regulation theory and reform requirements of the MSP.MethodsI.Document Analysis MethodIt focused on analyzing the relevant theories of the MSP,national and local policy documents,laws and regulations,work reports and institutional undisclosed information in the light of accessing to important literature at home and abroad.In addition,it was collected to the current price list of Medical Service Items（MSI）in various provinces（municipalities and autonomous regions）and cities,as well as national and local annual statistical yearbook and statistical bulletin on health.II.Theoretical Analysis Methodi.Institutional analysis method.It was used to summary institutional change course of the MSP and its main features and discuss institution supports and policy obstacles of the pricing and adjustment mechanism of the MSP in China under those social economic development process,health care system,social ethics and cultural background.ii.STEEPLED analytical method.STEEPLED is an acronym of the Social,Technological,Economic,Educational/Ethical,Political,Legal,Environmental and Demographic.It summarized the key factors affecting the price of medical services in public hospitals.II.Empirical Analysis Methodi.Questionnaire survey.The baseline survey data was collected about public hospitals reform in Wuhan,Hubei province.Those the basic situation of hospital,income and expenditure,staff income and balance of assets and liabilities in 2012-2014 were analyzed.Besides,the department costs of sample medical service items was collected in sample hospitals.ii.Focus Group Discussions.Fifteen price-related experts and scholars were selected to discuss key issues which were the reform policy and trend of MSP,difficulties in adjusting the MSP and so on.iii.Delphi method.Those factors affecting the MSP were ranked by consulting about thirty relevant experts or scholars who were hospital administrator,medical and health economic researcher,government health administrative department personnel,etc.Eventually,those key factors were identified for pricing.iv.Mathematical statistical analysis method.Excel 2013 was used to establish database,SPSS 21.0 and Excel2013 were used to analyze the collected data and perform statistical operation,such as multiple linear regression,variance analysis,rate comparison,etc.ResultsI.The incentive regulation connotation of the MSP has been defineed,and tiered control-price was established on the basis of the benchmark price and its fluctuations within limits by means of quality regulation.The profit and quality of medical services were considered in price regulation.The emerging tiered pricing model of medical service was formed,which were incentive for hospitals.II.The main features of institutional change course of the MSP in China has been summarized,namely gradual change under the combination of multiple factors,changing single price control to multi-centrality price governance,pilot reform of the medical service price were carried out by provincial governments,government dominance and its deep intervention,etc.III.Those key factors affecting the MSP has been found out.Those were health input and compensation of government,price reform polices of medical service and drug,price bureau,medical service cost,medical payment method,regional economic level and inflation rate,etc.IV.The traditional regulation effect of medical service price in China is not obvious,and the current price regulation of medical service has many problems,which were institutional barriers of the MSP,bereft interest-expressing mechanism,lack of price performance evaluation mechanism,imperfect regulation,incentive and accountability mechanisms,ill-defined price publicity system and social supervision mechanism,etc.V.The basic ideas for formatting the MSP and basic connotation for man-powered and auxiliary costs has been clearly defined.Furthermore,to construct the comprehensive conceptual model of medical service price formation mechanism,the adjustment factors of the MSP was determined as technical difficulty and degree of risk of the MSI,government subsidy,medical commodity price index,annual growth rate of hospital total assets,etc.VI.The original hospital classification standard（"level 3,class 10"）has not met the practical needs.The study constructed a new classification standard of "level 3,class 6",namely Primary-level Hospital,Secondary-level-A Hospital,Secondary-level-B Hospital and below,Tertiary-level-A Hospital,Tertiary-level-B Hospital,Tertiarylevel-C Hospital and below.VII.The connotation of medical service price formation mechanism,preliminary pricing model for medical services and benchmark price after negotiation with stakeholders were identified.The comprehensive tiered pricing model for medical services was finally produced with the medical service tiered pricing standard.The benchmark price and price-float range were determined for every MSI in every class of hospitals.Conclusions and policy recommendationsI.The formation idea of the MSP,the comprehensive conceptual model of pricing and the tiered pricing mechanismhas on the strength of medical quality has formulated.The comprehensive tiered pricing model for medical services:（a）The preliminary price:PΔg=[（1+MCPI）×（1+R）×（1-S/（1-S））]×(Cmanpower+Cauxiliary)（b）The benchmark price model after stakeholder negotiations:Pbenchmarkg=τ1P1g+τ2P2g+...+τnPng（c）The fluctuant tiered price:Primary-level Hospital:Constant price:Pconstant1=Pbenchmark1Higher prices:Phigher1=（1+x5）Pbenchmark1Lower prices:Plower1=（1-x4）Pbenchmark1Secondary-level-B Hospital:Constant price:Pconstant-B2=Pbenchmark2Higher prices:Phigher-B2=（1+x5）Pbenchmark2Lower prices:Plower-B2=（1-x4）Pbenchmark2Secondary-level-A Hospital and below:Constant price:Pconstant-A2=（1+x1）Pbenchmark2Higher prices:Phigher-A2=（1+x1）×（1+x5）Pbenchmark2Lower prices:Plower-A2=（1+x1）×（1-x4）Pbenchmark2Tertiary-level-C Hospital:Constant price:Pconstant-C3=Pbenchmark3Higher prices:Phigher-C3=（1+x5）Pbenchmark3Lower prices:Plower-C3=（1-x4）Pbenchmark3Tertiary-level-B Hospital:Constant price:Pconstant-B3=（1+x2）Pbenchmark3Higher prices:Phigher-B3=（1+x2）×（1+x5）Pbenchmark3Lower prices:Plower-B3=（1+x2）×（1-x4）Pbenchmark3Tertiary-level-A Hospital:Constant price:Pconstant-A3=（1+x3）Pbenchmark3Higher prices:Phigher-A3=（1+x3）×（1+x5）Pbenchmark3Lower prices:Plower-A3=（1+x3）×（1-x4）Pbenchmark3x1、x2、x3、x4、x5 were price fluctuation coefficient determined by the stakeholders.For other indicators,see chapter 6.The above tiered pricing formula is only the result of theoretical exploration,and its feasibility needs to be demonstrated in practice.II.It suggests that（a）strengthening the supervision subject and integrating medical services and insurance departmental resources,（b）improving the price publicity system and strengthening social supervision,（c）continuously carring out the price operation effect evaluation,establishing the incentive and accountability mechanism,（d）setting up expert demonstration system and social hearing system to enhance the participation of stakeholders,（e）liberating the price rights of medical services and promoting the payment method reform,（f）improving the tiered standards of medical institutions to build a tiered pricing mechanism for medical services,（g）transforming the mechanism of "earn extra profits" of medical institutions and strengthening hospital cost accounting,（h）building a service system of "smart medical" by the application of the medical informatization,（i）broadening the medical fundraising channels and promoting the fund security capacity.Innovation and limitationI.Main innovative pointsThe information asymmetry of medical services is taken into account,it is using the incentive regulation theory that the study explores the MSP formation mechanism problem of public hospitals.The comprehensive tiered pricing econometric model of medical services is constructed on the strength of the construction of the new hospital classification standard of "level 3,class 6" and the rating of medical service quality.Those higher,constant and lower prices in the same MSI of hospitals are produced by the model with some incentive.II.LimitationsSubject to objective conditions such as research period,data acquisition,reform policy and so on,it fails to carry out intervention experiments with the price calculated by the medical service comprehensive tiered pricing econometric model.At the same time,in the tiered pricing mechanism,there is no perfect tiered pricing system for the medical service quality. |
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