Economic Evaluation And Medical Security Policy Optimizing Research Of Dialysis Therapy For End-stage Renal Disease Dialysis

With the progress of science, technology, and the improvement of health condition, people’s life expectancy is increasingly extending, which makes the proportion of elderly population in total population gradually increased, accompanied by increasing chronic noncommunicable diseases. Chronic noncommunicable diseases has become a global problem, which not only leads to the growth of medical expenses, but brings about people, especially the elderly’s disability and descending quality of life, It deserves more and more attention. As the World Health Organization points out, the increasing prevalence rate of chronic diseases has threaten many countries’ social and economic development, as well as people’s life and health. Chronic diseases require long-term maintenance treatment and high medical cost, which renders "poverty due to illness, illness due to poverty" increasingly prominent at this stage. This is not only an economic problem, but also a serious social problem. In recent years, a series of hot news exposure by media brought end-stage renal disease patients’ medical security to the attention of the society. How to ensure the medical needs of patients with chronic diseases? International experience has shown that relying simply on increasing financial funding does not solve health care problem, what’s more important is how to use limited health resources efficiently.Due to the medical services’ being complex and highly specialized, medical institutions, medical insurance departments and patients each entertain asymmetric information. It is difficult for the market mechanism to adjust supply and demand of the total health service, which tends to cause the unreasonable use of health resources. Therefore, the medical service must be subject to strict monitoring and management. Regulatory economics is based on microeconomics and industrial organization theory, absorbing the relevant research results to develop. Along with the development of the regulation economics, the study is mainly on the enforcement agencies, whose synergy shall be brought into play, and cannot be ignored. It’s necessary to apply regulation economics to study government regulation of chronic diseases medical services. We should use economics evaluation method to choose more cost-effective treatment, guide the use of the prioritized treatment in the process of medical services provided by medical institutions.This study selects end-stage renal disease as an example, applying clinical medicine, epidemiology, and the related theory to comb its treatment characteristics, epidemiological trend and dialysis treatment organization and provision. Under the regulation economics and related theory, it is to evaluate and supervise the provider’s behavior, conduct economic evaluation of dialysis treatment, to seek more cost-effective treatment. Under the guidance of theory, such as health equity, welfare justice and incentive regulation theory, it is to study how to improve medical security of end-stage renal disease, and to optimize medical security payment pattern in our country. Based upon the literature study and expert consultation, we determine the cases selection standard, and perfect the investigation questionnaire. Through the non-randomized controlled trials study design method, we choose hospitals in the capitals of eastern, central and western provinces, which are all medical school affiliated hospitals: Zhejiang University First Affiliated Hospital, Anhui Medical University First Affiliated Hospital, Anhui Provincial Hospital, Xi’an Jiaotong University First Affiliated Hospital respectively, with the main content involving patients’ general condition, dialysis treatment cost, the burden of disease, clinical curative effect, quality of life and the status of health security, etc. Because this study is based on a design method of non-randomized controlled comparative trials research, we use propensity score matching method to handle the data for two groups, abominate groups so as for controllable variables from the two groups to achieve balance; we use ABC method to calculate the dialysis cost in two dialysis centers respectively; apply disease economic burden theory to calculate two dialysis direct medical cost, direct non-medical cost, indirect cost; apply subjective and objective index of clinical indicators and life quality score respectively to evaluate the curative effect of dialysis;use multiple regression analysis method to analyze the influence factors for quality of life, and related influence factors for the cost of dialysis; apply K-M survival analysis to compare HD and PD survival time to see whether there exists statistic difference; apply Cox’s proportional hazards regression model to analyze multiple factors of dialysis survival time, and apply SPSS17.0statistical software to collect and analyze research data.Through the theoretical research and empirical research, we draw the following main conclusions:(1) dialysis treatment equity is poor, while some patients reduce dialysis dose, or have the treatment by getting into debt due to financial reasons;(2) F.SRI) financial burden is heavy, we should give priority to cost-effective peritoneal dialysis treatment, towards which policy should be tilted;(3) medical institutions with their propensity have great influence on patients’choices, we should strengthen the supervision of medical institutions’ conduct;(4) although our country’s medical security reduces ESRD patient’s financial burden to a certain extent, but there still exists medical security compensation with narrow coverage, low level and poor fairness, which need to be further optimized;(5)regulation economics shall be applied to build scientific and reasonable medical security payment method, improve efficiency in the use of medical resources. Finally, we present suggestions in terms of the health security department, the health administrative department, the medical institutions and the society respectively, including:promoting health education actively, improving the integration of basic social medical security system in urban and rural areas, and implementing the same benefit standards, introducing the combined payment system of global budget and flat rate to optimize the medical security payment, rationalizing regional health planning, implementing community and specialized hospital linkage of two-way referral management pattern, increasing funding in the scientific research, encouraging nationalization of related main products for chronic non-communicable diseases treatment, strengthening the hospital cost accounting and control, and reducing excessively rapid growth of medical costs, etc.