Comparative Study On The Use Of High-value Medical Consumables In A Third-class Hospital Before And After The Implementation Of Zero-markup Policy Of Consumables

BackgroundCompared with low value medical consumables,high value medical consumables have the characteristics of high price,strong technology and high risk,It belongs to a kind of consumable material which acts directly on human body,has stricter requirements on safety,higher price and heavier burden on patients.After the drug markups were cancelled in 2017,high-value medical consumables gradually replaced drugs and became the new profit center of hospitals.The high price and overuse have attracted wide attention from all walks of life.In order to further regulate the behavior of medical services and control the unreasonable growth of medical costs,the government of China and Shandong Province issued relevant policies successively in 2019 to cancel the markups of high-value medical consumables.At present,researches on zero-markup policy of consumables are seldom combined with empirical data of hospital consumables use and patient hospitalization costs,so it is difficult to specify the effect of policy implementation.Before and after the policy implementation,therefore,this study,a third-class hospital changes the use of high value medical consumables and typical diseases(coronary heart disease and PCI surgery)in patients with stent and costs of empirical research,the use of standardized hospitals high value medical consumables for the future and further improving zero-markup policy provide countermeasures and suggestions.ObjectiveThe main purpose of this study is to explore whether the zero-markup policy can standardize the rational use of consumables and control the unreasonable growth of costs by analyzing the use data of high-value medical consumables and the stent use and related cost data of patients with coronary heart disease undergoing PCI surgery before and after the implementation of zero-markup policy of consumables in Hospital A.It provides a scientific basis for further standardizing the use behavior of high value medical consumables in hospitals and promoting the further improvement of zero-markup policy.Date and MethodsIn this study,domestic and foreign literatures related to the use of high-value medical consumables and zero-markup policy of consumables were obtained through domestic and foreign key databases,such as Web of Science and CNKI;Empirical data of consumable use and patient-related costs were collected through HIS system of hospital A and the centralized procurement system of high-value medical consumables;On the basis of literature research,the interview outline was designed by ourselves,and the key person interview method was adopted to interview the stakeholders(consumables supply management personnel and clinicians)of the use of high-value medical consumables in Hospital A to obtain qualitative data.Data in this study were analyzed and processed by Exce12016 and SPSS22.0.The changes in the use of high-value medical consumables,the use of stents,the cost and structure of hospitalization in Hospital A before and after the implementation of zero-markup policy of consumables were descriptively analyzed by means of constituent ratio,mean and standard deviation,chi-square test,Fisher’s exact probability method and non-parametric test;Spearman correlation test was used to analyze whether there was a correlation between the implementation of zero-markup policy and the change of stent usage and hospitalization cost in patients undergoing PCI surgery.Multiple linear regression model was used to analyze the influencing factors of stent usage in patients undergoing PCI surgery;The qualitative interview data adopted the thematic framework method,and two researchers transcribed and sorted out the themes,then summarized and analyzed the themes,and finally summarized the main problems existing in the emergence stage and corresponding countermeasures.Results(1)Standardize the use of consumablesAfter the implementation of the policy,the usage amount of high-value medical consumables in Hospital A decreased from 258,000 pieces to more than 243,000 pieces,A decrease of 5.68%;The use of stents in PCI patients decreased by 15.55%;The number of stent implantation per capita decreased from 2.11 to 1.88,a decrease of 10.9%.Spearman correlation test and multiple linear regression analysis showed that the implementation of zero-markup policy of consumables was an important factor affecting the amount of stent,and the amount of stent decreased with the implementation of the policy.(2)Disease burden of patientsAfter the implementation of the policy,the price of high value medical consumables was generally reduced;The average hospitalization cost of patients undergoing PCI surgery decreased from 62,300 yuan to 60,500 yuan,a decrease of 2.91%;Per capita health material cost decreased from 41,000 yuan to 38,700 yuan,a decrease of 5.58%;The cost of treatment,traditional Chinese medicine and other expenses have all increased.In terms of cost structure,the top three are health material cost,treatment cost and western medicine cost,among which,the proportion of health material cost decreased slightly,but still exceeded 60%.Before and after the implementation of the policy,there were statistically significant differences in the five medical service items of health material cost,western medicine cost,Chinese medicine cost,consultation cost and other expenses for patients undergoing PCI surgery(P<0.05).Conclusions and suggestionsIn general,Hospital A has basically achieved the expected effect of zero-markup policy on consumables,and has gradually improved in terms of standardizing the use of consumables and reducing the burden on patients.However,due to the influence of factors such as price-induced demand or patients’ irrational behavior of seeking medical treatment,the usage of a few types of consumables increased rather than decreased,and the per capita number of stent implantation in patients undergoing PCI surgery was also slightly higher than the average level at home and abroad.Therefore,it is suggested that the management should include this part of consumables into the focus of use standard management in the future,and further strengthen the supervision of clinical pathways.In addition,the structure of hospitalization costs for patients is unreasonable,there are problems such as excessively large proportion of health material cost and low increase of labor technical income,which have adverse effects on hospital operation and the enthusiasm of medical staff,and may lead to the phenomenon of shifting medical cost,etc.In the long run,it is not conducive to the realization of zero-markup policy goal of consumables.It is suggested that the government should establish a long-term mechanism of financial investment,and at the same time carry out empirical monitoring on the provision of medical services in hospitals,strengthen supervision,and dynamically adjust the price of medical services;Hospitals should adhere to the fine management mode,reduce costs,reduce waste,and complete the transformation from the short-term development path of relying on consumable material addition income to the sustainable development path of relying on business capacity and service quality.