| ObjectivesBy a comprehensive application of Theory of Incentives, basically incentive compatibility (IC) mechanism and system theory, the primary objectives of this study are to: i) thoroughly understand the development, organizational pattern, external and internal environmental factors of the regulation for the medical care quality in China, ii) recognize the current situation of medical care quality in China and list out the key factors to affect the regulation; iii) establish an assessment model for medical care quality evaluation, including the quantifying parameters used in the evaluation.Moreover, an incentive-regulation model for the quality supervision of medical care will be introduced, based on the Theory of Incentives. Further and deeper analysis will focus on its direct influence on the medical care quality and the correlations between them.Last but not least, with a goal of setting up a highly effective regulation pattern for the quality of medical care in China, this research aims to provide both theoretical and practical evidence to the political advices for a sustainable developed medical care system, which is suitable for China at present and future.Methodologies1. Literature review:By reviewing the relevant data from national and international literature, publications, and government reports, the current situation of the quality regulation in medical care, problems and difficulties existing in the administration were studied. In order to demonstrate the assessment model for medical care quality evaluation, the present study reviewed the evaluation dimensions for the interviews and consultations with experts based on the academic data. The content covered by the Theory of Incentives and its application in quality regulation or other relevant field were analyzed by literature studying.2. Expert consultation:A panel of professionals on the administration of the quality of medical care, hospital administration and relevant clinical fields were primarily proposed after the design of the consulting questionnaires for the experts. A total of 90 experts, in terms of health administration, hospital administration, clinic and medical care economy, were then selected to conduct a two-round consulting questionnaires in order to draft and finalize the assessment model of medical care quality evaluation.3. On-site Interviews:The methods of incentive regulation for medical care quality and the related data were collected from 150 hospitals in 15 provinces (the ratio of numbers of selected hospitals in east, west and middle region as 6:5:4). Meanwhile, two executive leaders and two administrators were selected in each hospital as interviewees to participate in investigations by questionnaires regarding to the development and knowledge of the quality regulation for medical care, in order to assess the practical situation and implementation of policies for quality control in medical care.4. Factor analysis:To explore the dimensions of medical care quality evaluation, factor analysis was conducted amongst the finalized quantitative parameters used in the quality evaluation model after expert consultation. Results of factor analysis contributed to set up a three-dimension system in terms of the quality, efficiency and cost of medical care service. Based on the weighted values of parameters calculated by factor analysis, combined with the comprehensive evaluation index analysis, the assessment model was constructed in order to quantify the evaluation of medical care quality.5. Multivariate logistic regression:The correlations between the different influence factors and the medical care quality were investigated by multivariate logistic regression analysis, specifically focusing on the different methods of incentive regulation. In the analysis, the scores for the quality of medical care calculated by the quantitative assessment model was defined as the dependent variable Y as well as different methods of incentive regulation seen as the independent variable X.The data used to analyze the quality of medical care was obtained from two major systems for quality control in the field of medical care. One is national health and family planning commission medical hospital authority medical information system (NICS) with the admission information of 38,950,647 patients in the range of 1174 hospitals. The other data source came from national health and family planning commission medical authority medical hospital quality measurement system (HQMS) containing 709 tier three hospitals providing the first page of medical record associated with 36,214,291 patients (the admission time is restricted from 2013.01.01 to 2014.12.31).Results1. According to the policy analysis about the regulation of medical care quality in China, the medical care regulation experienced different development stages, with respect to medical care price regulation, the access permit regulation of medical care institutions and medical staffs, the responsibility of the government in the process of supporting medical care services and so forth. It demonstrated a gradual transition from strict regulation to a relaxed pattern.2. Based on the analysis of the current allocation of medical care resources, the development of Chinese medical resources was clearly understood. Despite the increasing trend in total resources of the country, the geographical distribution of medical resources was unbalanced as well as in urban and rural area. As evidence, the needed number of beds per 1000 people in tier three hospitals in the region of east, middle and west were 1.04,0.85 and 0.79, respectively. There was also a disparity in the allocation of medical human resources with a continuously existing contradictions about the unequal distribution of high quality medical resources, the absolutely and relatively3. By analyzing the current situation of medical care quality in China, both data and information about quality were updated. The causes leading to the geographical differences in terms of medical quality were partially identified. The average length of stay in hospital was steadily around 10 days for discharged patients, which indicated that there is a large space to improve on the efficiency of medical care services. Compared to the middle and west, the number of beds was relatively fewer in eastern medical care organizations, approximately 1100-1600 beds by average. And the average length of stay was in the range of 8 to 10 days resulting in the higher efficiency of medical services. The medical security has been more guaranteed with a relatively lower overall mortality as 0.4%in hospital, while it represents the relatively higher cost in medical care.4. The establishment of evaluation model by the means of the quantification assessment. After expert consultation, ten parameters for evaluating medical quality were finalized as:the overall mortality in hospital, the average length of stay in hospital for discharged patients, the ratio of non-planned readmission 31 days post-discharge, the average cost in hospital, the percentage of patients using antibiotic drugs, the incidence of inpatient pressure sores, the secondary medicine cost proportion, the number of inpatients discharged, the ratio of non-doctor’s advice of departure from the hospital, the ratio of clinical transfusion reactions, etc. According to factor analysis, the sum of eigenvalues representing three factors have covered 76.349% of the total sum of ten factors, which means ten measurements has been classified into three groups representing the dimension of medical quality safety, medical service efficiency and medical service cost, respectively. Combined with the calculation of comprehensive evaluation index, the weight of each parameter and combined weight has been calculated to set up the evaluation model in terms of the quantitative assessment for medical care quality.5. The methods of incentive regulation regarding to medical quality included five aspects as price regulation (Xi), access regulation (X2), information regulation (X3), administration regulation (X4) and quality management regulation (X5). In the analysis, the scores for the quality of medical care calculated by the quantitative assessment model was defined as the dependent variable Y as well as different methods of incentive regulation seen as the independent variable X, which produced the logistic equation that was Y=1.707+2.157X2+0.867X3+1.747X4+0.004X5. It was indicated that there was a positive correlation between price regulation, access regulation, information regulation and medical quality.6. Propose the strategies of incentive regulation system for medical quality to suit with the present situation in China and its implementation pathways. In the basis of theoretical analysis and empirical researches, this applied as the references for decision-making and the theoretical evidences to the regulation pattern of incentive system establishment as well as policies making, by identifying major missions for each stage in the pathways.Conclusions1. The analysis of the current situation of medical resources and quality indicated the disparity of the geographical distribution of medical resources, especially unbalance in urban and rural. The high quality medical resources was far more concentrated in the region of the east with larger number of hospitals in small scales, in which medical care quality and service efficiency were generally at a high level. However, medical resources has been extraordinarily concentrated on several hospitals in the middle region with the less hospitals and the lower efficiency compared with the east. Besides that, there was an absolutely lack of medical resources in the west with the lower efficiency and the higher rates of referral, in which medical quality was to be improved.2. Three dimensions were used to evaluate the quality assessment for medical care which were medical quality safety, medical service efficiency and medical service cost. The dimension of medical quality safety included the overall mortality in hospital, the ratio of non-doctor’s advice of departure from the hospital, the ratio of non-planned readmission 31 days post-discharge, the incidence of inpatient pressure sores, the ratio of clinical transfusion reactions and the percentage of patients using antibiotic drugs. The dimension of medical service efficiency contained the average length of stay in hospital for discharged patients and the number of inpatients discharged. The dimension of medical service cost had two factors that were the secondary average cost in hospital and the secondary medicine cost proportion. Therefore, the data associated relative quality of hospitals has been successfully switched into the objective scores seen as the criteria evaluating the quality of medical care, which leaded to a transition from the subjective judgment into the objective assessment for medical medical care.3. Price regulation have imposed great impacts on the quality for medical care. Concerns about forming eligible price regulation contributed by bolstering the reform of various payment systems with the changes from the retrospective payment system into the prospective payment would be paid attention on effectively guiding medical organizations as well as controlling the medical charges by medical care supporters themselves. In addition, the therapeutic behavior provided by medical staffs could be strongly influenced by the incentive pattern of regulation.4. The methods of incentive regulation regarding to medical care included five aspects that were price regulation, access regulation, information regulation, administration regulation and quality management regulation. It was indicated by the logistic regression that there was a positive correlation between price regulation, information regulation, administration regulation and medical quality. What could be generally accepted supported by the coefficients of the regression was that price regulation and administration regulation have taken a huge effect on the quality for medical care.5. It will be a long term process to eventually construct the incentive pattern of regulation for medical care quality, which requires a series of procedures and stages. In the short term, the elementary work will be focused on improving the law with strengthening the implement of current regulations. While in the long term, priority will be given to further improving medical care in the basic law with legislation and to set up medical information platforms as well as optimizing management modes.Innovation and Limitation1.Innovation:(1) It is the first time to describe the current status of the medical care quality in China at a macro level by applying big data analysis. The present study involves a large scale of first-hand medical care quality data, relatively objective but representative enough, analysis outcomes by using information methods to collect, reorganize, count and analyze. The data is collected from above 1100 hospitals, in which 700 are tier 3 hospitals. There have been no such reports until present study on medical care quality information based on analysis on data in such large scale.(2) To establish medical care quality quantitative evaluation system which is suitable for China’s current status, by comprehensively using expert consultation, factor analysis, and integrated index. The innovative part of this study is that it selects medical care quality evaluation indicators by using statistical analysis and explains the connections between different indicators. Meanwhile, the indicators are assigned weights in a scientific way so that a quantitative indicator system for objectively evaluating medical care quality is set up. Empirical research is performed. Currently there is no similar reports.(3) For the first time, a relatively completed medical care quality supervision model was established based on "incentive-regulation" theory, and by using statistical analysis to set up Logistic regression equation between "incentive-regulation" method and medical care quality, to further explain influence occurs and the connection between them. Currently there is no similar reports.2. Limitations:Restricted from objective conditions, the data is obtained by sampling methods by the Institute. Although the sample covers a relatively large area, there may still some impacts on the precision of the research results. Besides, the data collected from the questionnaire of this study is based on the perception of the respondents from their working experiences and understanding of the research contents, which may also affect the objectiveness and science of the data. |
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