Study On The Mode Of Government Purchase Basic Medical Service

PurposeThis study takes the discussion on trial of restricted price management for single-disease in Yiyang County of Henan Province as background, based on fully learning from the research achievements including new public management theory, stakeholder theory, strategic purchase theory, system design theory and the theory of law of large numbers, it creates the theoretical model for government purchase basic medical care service respectively from the macro, medium and micro level, specifies the responsibility relationships of various interest parties, determines the core purchase system and monitoring and evaluation system, and conducts optimization and improvement to theoretical model and operation mechanism through the practice certification, which aims to provide theoretical guidance and strategy support to carry out government purchase in the field of medical service and offer reference for further implementation of government purchasing health in theory and experience.Methods1. Literature Research. With assistance of Chinese and English electronic library of Huazhong University of Science and Technology and Pubmed Medline, it has retrieved over600academic papers with Chinese and English version during2000to2013, applies induction and sorting methods to provide theoretical lesson and reference for design government purchase basic medical service model and operation mechanism.2. Expert-consulting Method. Invite4experts and scholars from the file of health policies, hospital management and medical insurance and5leaders from Health Bureau, Management Committee Office of New Rural Cooperative Medical System and the People’s Hospital of Yiyang County to make up expert group and conduct consulting discussion on the theoretical frame, operation mechanism design and evaluation index system determined in this study.3. Spot Investigation. Use key informant interviews, choose12leaders participating reform of relevant institutions including Health Bureau, Management Committee Office of the New Rural Cooperative Medical System, the Human Resources and Social Security Bureau and the People’s Hospital of Yiyang County for depth interview; choose14patients recently discharged from different clinical department for a interview. Design the institution questionnaire, by which collects the data of the People’s Hospital of Yiyang County before and after the reform; questionnaire survey method: choose different clinical departments and take randomly15doctors and nurses respectively to conduct questionnaire survey.4. Comparative Method. Make the vertical and horizontal comparative analysis on monthly monitoring data of the People’s Hospital of Yiyang during Nov.2010to Oct.2013in accordance with the designed indexes, provide data support to evaluate and optimize government purchase basic medical service model in this study.5. Data Disposal and Analysis.Collecting and sorting information should be carried out strictly according to honest principle, especially the spot investigation, strive for the true, complete and firsthand data. The data of questionnaire survey is entered in double with Epidata3.2in order to ensure quality. The quantitative information will be secured by continuous monitoring and statistics with Excel2010to analyze dynamic changes of various quantitative monitoring and evaluation indexes of government purchase basic medical service of Yiyang County.The analysis on qualitative data will be conducted through the evaluation, cognition and satisfaction of interest parties on reform by using methods including classification, induction and health policies analysis.Outcomes1. Construct theoretical model of government purchase basic medical service. On the basis of outcome orientation, construct the responsibility system, purchase mechanism and monitoring and evaluation system from the macro, medium and micro level.2. Construct the government purchase basic medical service model with responsibility system, purchase mechanism and monitoring and evaluation system as its core. The responsibility system mainly specifies the responsibilities of government, medical insurance agencies, service provider and patients; purchase mechanism includes five mechanisms such as quality assurance, price negotiation, performance payment, comprehensive supervision and information management; monitoring and evaluation system has4categories and15indexes for monitoring and evaluating.3. Design the new thinking patter of group management and classification payment according to clinical path of disease, carry out management to one disease by dividing it into Group A, B and C clinical path, which resolves the low inclusion rate and high dropout rate during traditional clinical path management, ensures the complete coverage and achieves the optimization and improvement to theoretical model and operation mechanism of government purchase basic medical service.4. This study proposes efficient implementation strategies of government purchase basic medical service model, which mainly include overall quality management strategy, performance contract management strategy, group and classification payment strategy, price negotiation strategy, comprehensive supervision management strategy and other technical support strategies, insuring the efficient implementation of this model and operation mechanism.5. Through the promotion on pilot, until October of2013, the disease types included in clinical pathway management in the People’s Hospital of Yiyang County have reached188, the ratio of included patient and discharged patient as well as the expense ratio has both got to70%, inclusion ratio of single-disease reaches100%, the ratio of patients included in clinical pathway management group A, B and C has kept respectively70%,20%and10%; with a implementation conformity of over85%; the average length of hospital has reduced, proportion of drugs and usage ratio of antibiotics respectively declines by16%and13%, and gets to32%and10%, the cure rate of included patient over98%; unreasonable growth of every hospitalization expenses has got control, the expense constitution gets optimized gradually; increasing satisfactory of interested parties including medical personnel, medical insurance agencies, patients and government; the actual compensation ratio of included patient has got to70%, higher than the actual compensation level55%of health institutions at county level in Henan Province.ConclusionThe empirical study proves that the pattern of medical service provision by governmental purchase of basic medical service designed by this research conforms to the objective and direction of health and medical reform in our country. The effect of the reform and exploration is quite noticeable and is better than those of other domestic reforms. In particular, the new management concepts and measures such as "management by grouping and payment by classification", which is proposed on the basis of clinical path of diseases according to traditional clinical path management, have greatly improved the level and efficiency of standardized management of clinical path. The management pattern for governmental purchase of basic medical service developed by this research can offer theory and experience for governmental purchase of health.Innovation and DisadvantageThe innovations embodied in this research include the following:1. Designing theoretical model and operating mechanism for the pattern of governmental purchase of basic medical service;2. Proposing the thinking of "management by grouping and payment by classification" based on clinical paths of diseases according to the concept of overall quality management;3. Suggesting overall supervising strategies like "same-industry supervision, third-party evaluation, executive accountability system, buyer evaluation and computer-aided supervision.Shortcomings of this research and points to be improved:1. The method for cost calculation for single-disease needs to be improved. The current method is still based on "respect current situation", failing to solve problems in cost structure and level. Cost is the basis for any price system, thus research and practice in the future shall study further how to improve cost calculation.2. The standardization degree of clinical path needs to be improved for wider application. The methods for path-making and pricing in this research take into consideration special characteristics of local medical institutions, which is beneficial to the launching and promotion of reform on governmental purchase of basic medical service. However, this practice also results in problems such as different path and different price for same disease in different areas, indicating that more attentions are needed for standardization of path-making and pricing.3. The analysis method of this research needs to be improved as the analysis lacks interference comparison. This research only focuses on Yiyang and lacks comparison analysis of the interference group, resulting in limit of the research conclusion.