B Large Medical Equipment Allocation Planning And Management Of The Policy Research

[Objectives] With the development of medical technology and economy, major medical equipment has become an important part of the material technology in medical institutions. The use of major medical equipment improves the level of diseases diagnosis and treatment greatly. How to use major medical equipment in a reasonable and effective manner is an urgent problem to be solved under the background of the new round of health care reform in China. By analyzing the current situation of allocation and utilization of class B major medical equipment in China, this thesis aimed to provide recommendations for management of class B major medical equipment.[Methods] Literature review and field survey methods were used to describe the current status of class B major medical equipment in Shanghai city and Shaanxi, Zhejiang and Hunan province and to find out problems in equipment management. The mathematical models were used to forecast the number of class B major medical equipment in2015. According to the research data, we also analyzed the impact produced by equipment usage on medical expenditures.[Results]1、Allocation of class B major medical equipment such as CT, MRI in China was in a reasonable range.In2009, the numbers of CT, MRI, DSA, SPECT and LA per million populations were6.29,1.60,1.28,0.81and0.35, respectively. The allocation numbers of class B major medical equipment in surveyed provinces and cities were not very high compared to other countries. For example, the numbers of CT and MRI per million populations in Shanghai were7.6and3.2in2009, which were far below the OECD medians, with23.7and12.3per million populations, also below the amount in Turkey which had a similar socio-economic level with China.2、Government investment needs to be improved for class B major medical equipment allocation.In the purchase of major medical equipment, investment amount of the government was different among regions. The amount of Shanghai was the largest but only with a rate of30%to60%. Shaanxi Province’s rate was the lowest with10%or even lower.3、The usage of CT increased significantly both in outpatients and inpatients; MRI and DSA increased moderately; the usage of LA, however, reduced. According to the sample hospital data, the number of patients for CT scanning in outpatient and emergency department in2005accounted for2.29%of the total number and the rate grew to3.29%in2009. The rate for MRI in2005was0.40%and it grew to0.62%in2009. For DSA, the value was0.02%in2005and0.03%in2009. For SPECT, the value increased from0.14%in2005to0.15%in2009. For LA, the rate was1.55%in2005and1.20%in2009. Generally, the usage of Class B major medical equipment in the outpatient was little and the number of CT usage grew fastest among all the Class B equipment.Compared with usage rate in outpatients, there was a higher proportion in inpatient cases. Among all inpatients, CT utilization rate in2005was38.49%and this number rose to49.86%in2009, which implied that CT had become one of the routine inspection items in inpatients. For MRI, the rates were11.36%and16.05%, respectively, in2005and2009. For DSA, the rates were4.61%and5.39%respectively, in2005and2009. For SPECT, the rates were5.40%and5.14%and for LA, the rates were20.53%and5.04%, respectively. It reflected that the utilization of CT increased fastest and was common in inpatient services. MRI and DSA had a slow growth in use while the usage of SPECT and LA decreased from2005to2009.4、In general, the usage of class B major medical equipment was appropriate, however, there were cases demonstrating inappropriate use of the equipment.The1570sample inpatient medical records were evaluated by experts according to the principle of clinical audit.88.53%of CT was used appropriately while11.47%unreasonable. The overuse rate of CT was2.65%while the underuse rate was8.83%.93.34%of MRI was used appropriately while6.66%was unreasonable. MRI was with an underuse rate of6.22%while the overuse rate was0.44%.98.09%of DSA was used reasonable and all inappropriate cases for DSA usage were underuse. Excessive use and under use coexisted. Logistic regression showed that hospital-level, whether taken a surgery and the average lenth of stay had a certain influence on appropriate use of equipment.5、Utilization efficiency varied among hospitals in different regions. Taking CT for an example, the capacity utilization ratio was high in some regions, reaching50%, but in some regions the average ratio was only30%of the maximum quota capacity. MRI capacity utilization ratio was lower than CT, with an average of40%. There was a gap of40%among the largest and smallest provinces. Capacity utilization ratio of DSA in Shanghai was the highest, reaching26%, and remained20%in other provinces. The ratio of Shaanxi Province was less than10%.6、The numbers of Class B major medical equipment in2015were forecasted through exponential smoothing, health demand method and time-lag model, respectively. The forecasted numbers of CT, MRI, DSA, SPECT and LA in2015will be11015-17181,4347～5734,2089～3754,786～1374and1374～2564, respectively.7、The usage of major medical equipment caused medical cost increment. The multiple linear regression models showed the factors that affected health care costs were the hospital-level, conditions when patients were admitted to hospital, lenth of stay and whether the patient had a surgery. Costs in tertiary hospitals were3696yuan more than secondary hospitals; compared with critically ill patients, costs for emergency patients and normal patients reduced by3862yuan and5286yuan; when the age increased one year, the cost increased89yuan; lenth of stay and costs were positively correlated with a change of344yuan/day; the cost difference between surgery patients and non-surgery patients was up to4100yuan; the numbers of CT, MRI, DSA scanning and costs were positively correlated, however, only the number of DSA scanning was statistically significant and fitted into the model. The cost would increase3724yuan if the patient had one more scan.8、The problems of class B major medical equipment provision and management needed to be solved.The sample provinces allocated the equipment in accordance with the rules strictly. However, there were still some problems of class B major medical equipment provision and management with the development of medical technology and the growing demand for health services, such as irrational provision index allocation and shortage of basic-level hospital allocation; high maintenance costs of imported equipment; vacancy of operation personnel and training management system. Qualitative interview showed that most managers of medical institutions called for an adjustment on supervisory intensity and items of class B major medical equipment to release the strict quotas for the numbers of equipment in all regions.[Recommendations]1、Uphold the basic principles of health care reform. In the process of allocation, utilization and management of class B major medical equipment, we must adhere to the basic principles of health care reform, establish and improve the basic health system that covers both urban and rural residents, and provide people with safe, effective, convenient, affordable medical and health services.2、Make scientific and reasonable regional health planning of equipment. Social and economic development, population structure, the continuous improvement in the extent and level of medical insurance, class B major medical equipment’s own technical progress, the income level of citizens, ratio of the rural and urban population, medical personnel, condition of facilities, residents’health status, health service utilization and costs, etc. would have influences on the usage of class B major medical equipment. Variation trend of these indicators should be considered when making configuration plans.3、The macro-governance policy on class B major medical equipment should be optimized during the health care reform.Some mechanisms for class B major medical equipment should be developed and improved through a long term and sustainable perspective, including distribution, investment, monitoring and evaluation. Equipment allocation and investment should be considered according to the growing basic medical needs of the public. More preferential policy should be given to the primary hospitals, rural areas and the western hospitals, and to institutions with large amount and high quality services.