A Comparative Study On The Regional Price Of Medical Service

[BACKGROUND]In the2009Health Care System Reform, it was put forward clearly in the public hospitals reform section that efforts should be made to improve the compensation mechanism of public hospitals, through appropriately adjusting medical service prices and increasing government investment, and gradually reform the mechanism of compensating the medical cost through drug sale. Medical service pricing is the key. Since fees are charged by service items, the nature of this reform is changing price management of these items.Items have been well regulated since2000step by step. But regulation of prices still has a long way to go. The huge difference among regions exists because of the provincial level pricing rights and lack of national adjustment. The central government has paid more attention to this problem. In the file "Opinios of Reforming Drug and Medical Service Pricing Mechanism", Nov.2009, it said that State Council would strengthen its guidance and coordination to medical service pricing.An important prerequisite and foundation of regional price coordination is to formulate a set of method for medical service price comparison and evaluation. In this research, we hope to propose such a set of methods that can be used to compare the prices among different regions, basing on the analysis of price management history and the present situation. Now the government departments are not using any tools to do this comparion directly. Also, there’s no research focuses on systematical cross region comparison in the academic field, which brings difficulty to control health care prices at national level.[GOAL、CONTENTS&METHOD]Based on the background above, this study describes the main management policies since2000by collecting medical service price policies and research literatures, combined with qualitative research and quantitative research methods. Then we take13provinces, Guangdong, Liaoning, Shandong, Shaanxi, Hebei, Heilongjiang, Jiangsu, Ningxia, Chongqing, Fujian, Hunan Sichuan and Zhejiang, as samples to carry on the analysis of item setting, and compare price levels of these13provinces by items and Purchasing Power Parity separately.CURRENT STATUS OF MEDICAL SERVICE PRICE MAGEMENTMost provinces set medical service items in accordance with national standards. The decomposition and innovation of items widely exist.11.16%of items on average are created by decomposition of national ones and an average of0.98%are new items innovated by provinces. The2012version of "The National Medical service Price Standard" has9360items, almost twice the amount of the2001version. Also there are obvious changes in classification coding rules in this new one.PRICE COMPARISON BASED ON ITEMS In price comparion based on items, we divide it into three levels, the overall price level, price level by categories and by representative items. In general, the price difference among provinces is large. The average price of13provinces including all items is680.09yuan. Heilongjiang is the lowest with290.18yuan, and Guangdong is the highest, which amounts to944.90yuan,3times more than the former. At the same time, the variance of price wihtin province is also different. Heilongjiang is relatively the most concentrated, while Sichuan is relatively the most dispersed. When compared by category, operation related items are relatively high in price. For example, organ transplantation, heart and lung transplantation, transplantation liver resection plus grafting operation are the common top5highly priced items in several provinces. In the comparison of representative items, we take expenditure percent as the standard of representativeness. The five kinds of diseases including common bile duct stones are chosen as samples. Representative items are picked out through the clinical path method by screening top ten items with high costs.PRICE COMPARISON BASED ON INDEXESThe purchasing power parity, a theory in international price comparison, is applied in this study as an indexation method for the comparion of medical service prices.Classification of third levels is taken as basic heading. All items with a price are counted. We get expenditure weight by clinical pathway method and finally achieve multi-province comparison by connecting bilateral ones using the MST method and EKS method. Four diseases, coronary heart disease, cerebral hemorrhage, gastric cancer and chronic obstructive pulmonary disease (COPD), are chosen as samples. Expenditure weights of each basic heading are calculated by the expenditure proportion both within disease and among diseases. The result of price index comparison shows the following order from high to low:Guangdong, Sichuan, Shandong, Shaanxi, Liaoning, Chongqing, Fujian, Hunan, Zhejiang, Heilongjiang, Jiangsu, Ningxia and Hebei, by MST method. The result of EKS method is similar to MST method, except that Fujian is slightly higher than Chongqing and Heilongjiang is slightly higher than Zhejiang.[DISCUSSION&SUGGESTION]In the management of medical service prices, it is important that we monitor and adjust price levels not only for longitudinal changes but also in a horizontal perspect. That’s why the methods and tools for cross region comparion are of high importance as strong graspers. The core of this study is to explore the suitable way from the perspective of regional comparison. To combine with the clinical pathway to select representative items and calculate the expenditure weights, and to design cross region comparison by learning purchasing power parity theory from the macro economic field are the two innovations here. Because of the limited relevant data, the difference between comparison results captured in this study and in the real situation remains to be tested.Based on the above conclusions, this study provides two proposals from the regulation of healthe care service price and treatment process. We should improve the price formation and adjustment mechanism and establish regional coordination system, and to promote the diagnosis and treatment behavior by further improving clinical pathway specification at the same time.