Single Disease Cost Control Study Based On The Clinical Pathway

Objective The study select Helan Center Hospital which uses implementation ofclinical pathway management and single macro-reforms method as sample hospital,and then choose5kinds of single diseases that the case number of every disease mustbeyond10. Medical service cost calculation method is used to calculate the cost ofsingle diseases, firstly, compare the cost, and then make a longitudinal comparison ofthe expense of diseases, finally, analysis the effect of expense control. It offers a newmethod for the medical service payment system reform, and also provides feasiblesuggestions for the method based on single macro-reforms of clinical pathwayfatherly.Methods Using a combination of qualitative and quantitative method. Qualitativeanalysis disease expense control effect, quantitative analysis hospitalizationexpenses,and the total fee, Spearman rank correlation correlation analysis is used onanalyzing the cost of hospitalization and inpatient age, duration of hospitalization,drugs accounted for.Results The costs of five disease (Fracture fixation removal surgery, caesareansection, hypertension grade III, inguinal hernia, bronchopneumonia) in clinical pathare loss than the disease average cases expense and the cost of disease. There is no significant difference between the five single disease (the fracture fixationremoval surgery, caesarean section, hypertension grade III, inguinal hernia, bronchialpneumonia) disease and pay-by-project group on patients age, gender, and duration ofhospitalization, the two groups are comparable;1.The average expense of single-disease of Fracture fixation and extraction is g lowerthan the expense of pay-by-project, the difference medicine fee, surgery fee,laboratory fees, nursing fee, radiology fees, and the total expense is statisticallysignificance, which gets the goal of control care expenses, main affecting factors ofhospital costs are the proportion of drug and length of stay.2.The average expense of Cesarean section single disease is2288.46yuan, theaverage expense of pay-per-project is2370.77yuan, the difference of Wilcoxon ranksum test is no statistically significant, dose not meet a expense-control effect;3.The average expense of single-disease group of Hypertension grade III is lower thanthe expense of pay-per-project group, the mean value of11categories ofhospitalization expense are less than the pay-per-project group, the Wilcoxon ranksum test analysis results show: the difference medicine fee, surgery fee, laboratoryfee, nursing fee, radiology fee, and the total expenses are statistically significant,indicating that the average expense of the disease group is lower than the projectgroup,which meets the purpose of control fees;4.Single disease group of Inguinal hernia is1715.60yuan, the expense of paid by theproject group is1809.53yuan. Wilcoxon rank sum test is statistically significant, theaverage expense of disease group is less than the project group; 5.The average expense of single disease group of bronchial pneumonia is838.77yuan,pay-per-project group costs905.18yuan, Wilcoxon rank sum test is not statisticallysignificant, no difference in the total expense of the two groups of hospital charges,the effect of the single disease expense control not obvious; the main factors ofunivariate analysis are the proportion of drug and length of stay.Conclusion The expense of clinical path on the five disease (Fracture fixationremoval surgery, caesarean section, hypertension grade III, inguinal hernia,bronchopneumonia) are less than the disease cases.The expenses of clinical pathway-based single-disease system on Fracture fixationand extraction, hypertension grade III, inguinal hernia three diseases are significantlyless than The single disease Pay group average hospital cost, which can control theunreasonable growth in hospital costs, and achieve the purpose of control fees.Cesarean section, bronchial pneumonia single-disease group of hospital patients werecost slightly less than the pay-per-project group, but not statistically significant, thecost of a single disease control effect is not obvious.Recommendations1. Strengthen the construction of hospital informatization2. Strengthen the standardization of disease diagnosis classification3. Improve macro-reforms standard calculation method4. Strengthen the cost accounting of hospital and improve management ability ofclinical pathway5. Improve the quality of control measures and evaluation system 6. Reform of hospital internal performance evaluation standard, establish thecorresponding incentive mechanismCalculate costs, formulate reasonable standard of macro-reforms based on theimplementation of clinical pathway, practice single disease payment system, broadenthe coverage of disease, at the same time, meet the purpose of controlling the growthof medical expenses.