Research On The Index System Of Factors Influencing The Dynamic Adjustment Of Basic Medical Service Prices In Guangdong Province

BackgroundFor a long time,there have been problems in China such as medical service prices deviating from value,lagging price adjustment and unreasonable price comparison.The establishment of a dynamic adjustment mechanism for medical service prices has become a key concern of the health care reform policy,and a series of reform documents have been issued successively.in December 2019,four national ministries and commissions jointly issued a special "opinion on the dynamic adjustment of the current price of medical services"(medical insurance hair[2019]No.79),requiring provinces to "establish and improve the dynamic price adjustment mechanism for medical services Adjustment mechanism,steady and orderly pilot exploration of medical services price optimization.By dynamically adjusting the prices of medical services,the price ratio of medical services will be gradually rationalized".Based on this,this study aims to draw on the theory of social stability risk assessment of major decisions,using the Delphi method and fuzzy comprehensive evaluation method to study the construction of basic medical service price dynamic adjustment impact factor index system,to provide reference for Guangdong Province and the country to deepen the medical service price reform.ObjectiveBased on the relevant health care reform policy requirement documents and literature research,we combed the indicator pool,explored the construction of a set of scientific and feasible basic medical service price dynamic adjustment impact factor indicator system and a set of basic medical service price dynamic adjustment initiation and constraint indicators in line with Guangdong Province,and provided theoretical and decision-making basis for the government to formulate the basic medical service price dynamic adjustment policy.MethodsThe methods used in this study include collecting and sorting out impact factor indicators using the literature research method,determining the indicator system by questionnaire consultation through the expert consultation method(Delphi method),and calculating the indicator weights using the fuzzy comprehensive evaluation method.Results(1)Constructed the index system of impact factors for dynamic adjustment of basic medical service pricesBased on the theory of social stability risk assessment of major decisions,four primary indicators of rationality,controllability,feasibility and sustainability,11 secondary indicators and 34 tertiary indicators were selected;through Delphi method questionnaire consultation,boundary value method to screen indicators and fuzzy comprehensive evaluation to determine the weight of indicators,finally formed 4 primary indicators,10 secondary indicators and 36 tertiary indicators of basic medical services The price dynamic adjustment influence factor index system was formed.The recall rate of the two rounds of questionnaire was higher than 90.0%;the authority of experts was 0.906>0.70;the coordination coefficient of the two rounds was higher and the test value was P<0.05.The weights of the primary indicators were ranked as:reasonableness,controllability,feasibility and sustainability.Among the secondary indicators,the affordability of medical insurance,changes in medical income structure and medical cost control ranked in the top three.Among the third-level indicators,the proportion of medical service income to medical income,the increase of medical expenses and the number of months that can be paid by medical insurance fund are ranked in the top three.(2)Constructed the dynamic price adjustment of basic medical services in Guangdong Province to start and constrain the indicatorsFrom the constructed three-level indicators of the basic medical service price dynamic adjustment impact factor index system,nine indicators with large weight coefficients were selected as start-up and constraint indicators.According to the quantitative value of the assessment of the indicator in the policy document,the indicator criteria were set,and the starting and constraining indicators were distinguished according to the internal logic of the influence of the indicators on price adjustment.In this way,a set of start-up and constraint indicators for dynamic price adjustment of basic medical services in Guangdong Province was established,including specific reference indicators,criteria,definitions,etc.(3)Suggestions for the policy of dynamic price adjustment of medical servicesEstablish a sensitive and moderate price dynamic adjustment mechanism,clarify the price adjustment start-up and constraint conditions;build an optimized and efficient medical service price adjustment procedure,and improve the degree of price adjustment refinement;establish a simple and easy-to-use pricing model for medical service price adjustment,and optimize the price adjustment support system;clarify the practical path of medical service price dynamic adjustment;do a good job of price monitoring and evaluation and supervision and inspection,and ensure the stable operation of the price mechanism.Research ConclusionThis study has constructed the index system of influencing factors for dynamic price adjustment of basic medical services in Guangdong Province through literature research method,expert consultation method and fuzzy comprehensive evaluation method,and the whole process is scientific and objective;the formed constraint index for dynamic price adjustment of medical services in Guangdong Province has become the reference basis for policy issuance of Guangdong Provincial Medical Insurance Bureau;the borrowed theory of social stability risk assessment of major decisions provides a theoretical reference for medical services in China The theoretical reference is provided for the price adjustment of medical services in China.