Research On The Effect And Risk Assessment Of Medical Service Price Reform Policy From The Perspective Of Public Policy

Research purposesThe comprehensive evaluation framework of medical service price policy is designed from the perspective of public policy,which provides basic ideas and methods for evaluating the reform policy of medical service price.Based on a large number of data and interviews on the implementation of the price adjustment policy for medical services.,the statistical analysis method such as the double difference method is used to judge the effectiveness of the verification policy.Effectiveness evaluation is carried out according to the actual implementation status and efficiency of the policy,therefore put forward policy suggestions and risk countermeasures to improving the dynamic adjustment of medical service price reform.Research method1.Documentary data method:Through literature research,analyzing domestic and foreign public policy,medical service price reform,policy effects,dual difference model,risk assessment and related literatures,the study does evaluation for status and effects of current medical service price reform policy management,and make summary of relevant researches on policy evaluation of medical service price reform.2.Difference-in-difference(DID)model:In order to evaluate the reform effect,the study applies double differential DID model to analyzes the differences among hospital cost control level,medical expenses,income and expenditure structure,service volume,medical service efficiency and other indicators before and after the implementation of the policy,3.Questionnaire method:A questionnaire on the compensation situation in public hospitals is designed to understand the current compensation situation.Based on policy analysis,literature research and public opinion survey,the study gets across to the cognition of patients and medical staff on the reform and collect risks caused by the policy implementation through the questionnaire on the cognition of medical service price reform.4.Risk matrix method:The study discusses the main risk factors of brainstorming by selecting experts in relevant fields.Qualitative analysis and quantitative analysis of risk events are applied to assess the potential impact of risk events and the probability of risk occurrence.5.Expert Consultation method:20 members of the expert group covering clinical medicine,financial management,health and economic management are consulted to establish the risk level of medical service price reform.Research findings and conclusions1.The price compensation is basically reasonable,but further structural adjustment is still in necessary.Although public hospitals have achieved effect to a certain extent in the adjustment of medical service price,the evidence for adjusting the medical service price is weak,the accuracy of measurement is insufficient,and the medical service cost,technical requirement and risk degree are not fully considered.The actual compensation of most hospitals is in line with the reform expectations,but the compensation rates among hospitals of various categories and levels are relatively unbalanced,and some hospitals have a big gap in the compensation rate.2.Public hospitals in Guangdong province are generally running well with a slight surplus in revenue and expenditure,and the income structure has been gradually optimized.From 2015 to 2017,the total revenue and total cost of public hospitals in the whole province has kept growing,with the growth rate exceeding 10%and the average annual balanced for the three years.More than 75%of the hospitals were able to maintain financial balance,and keep the economic operation of the hospitals in good condition.However,hospital balances have narrowed over the years.After the elimination of medicine markup and the adjustment of medical service price,the drug income and its proportion has gradually decreased,and the project income reflecting the value of medical service personnel has increased rapidly,indicating that the income structure of medical services has realized positive adjustment,the hospital income structure has been optimized,and the medical service price has been gradually straightened out,which is in line with the expectation of the reform policy.3.The volume of medical services has increased and the cost increase has been controlled.The service volume of public hospitals in the province continues to grow steadily,with visits and discharges increasing year by year.The growth rate of outpatient fee per time has slowed down,and the inpatient fee per time in 2017 has decreased year-on-year.4.Difference-in-difference model empirically shows that the policy may have a hedge.The verification is established that the price policy has positive effects on reducing medical expenses,improving cost control level,and improving hospital revenue and expenditure structure.The verification is not established that the price policy has little or no effect or even reverse effect on medical service efficiency and the workload,which shows that the policy has two sides and needs to work together with other policies.5.There is a certain price risk,and risk prevention measures must be strengthened to achieve policy optimization.Through analysis,it is found that there are four major kinds of risks in medical service price reform:decision-making risk,operational risk,social risk and other risks.Specifically,there are 12 items as follows:(1)1 item is determined to be very high risk level,which is that most of the public hospitals affiliated to the ministry have the risk that the actual compensation for price adjustment is less than 80%.(2)9 items are determined to be high risk level,including risk affecting the implementation of policies to improve the salary and treatment of medical staff,risk declining high level medical treatment,scientific research and teaching ability in large provincial and ministerial-level tertiary hospitals,risk leading to unreasonable price ratio of medical services caused by the implementation of the "one hospital,one policy" policy,risk of hospital income and expenditure imbalance,risk causing patient dissatisfaction because of the increase of some patients' medical expenses,risk of large-scale instruments'overuse because the inspection price is greatly reduced,risk of declining quality of hospital pharmaceutical services,risk of charging chaos because of hospital information systems' delayed connection and risk of media hype.(3)2 items are determined to be medium risk level,which are risk declining the external support and assistance capability of large provincial and ministerial tertiary hospitals and risk affecting the implementation of the grading diagnosis and treatment policy.Policy suggestion1.Perfect fair,scientific and reasonable hospital compensation mechanism and improve the compensation rate.First,improve the financial input policy and increase special compensation for public hospitals.Second,hospitals should improve the level of refined management,strengthen hospital cost control,improve the efficiency of resource utilization,and achieve "cost reduction and efficiency increase".The third is to properly balance the compensation rates of different public medical institutions in the same city by adjusting prices in the next reform2.Establish a dynamic price adjustment mechanism based on changes in cost and income structure.First,strengthen cost supervision and auditing and cost monitoring,and adjust the price of medical project dynamically according to the cost.Second,adjust the rise and fall simultaneously.Third,coordinate price adjustment with medical expense control and hospital income structure change.The fourth is to learn from and follow the strategy.Based on the experience of Shenzhen,Beijing,and Shanghai,the pricing methods of "marketing method" and "price shifting method"are adopted to adjust the prices of current medical service projects.The fifth is to standardize the hospital cost accounting system.3.Establish a mechanism for coordinating regional prices to rationalize the inter-regional price comparisons.The first is to standardize the name and code of medical service projects in public hospitals in the province.The second is to establish a unified price policy platform for information disclosure.The third is to establish the guidance price of medical service projects in the province,and guide the cities to adjust prices reasonably.The fourth is to implement regional coordination in the four regions of East Guangdong,West Guangdong,North Guangdong the Pearl River Delta.4.Promote health system reform and strengthen the comprehensiveness and synergy of policies.The first is to make good use of medical payment leverage.The second is to strengthen the comprehensive supervision of medical services.The third is to improve the centralized procurement system for pharmaceuticals and high-value medical consumables.Under the goal of the hierarchical diagnosis system construction,the fee-control policy requires comprehensive reform and policy linkage,and is in line with other reforms.5.Improve the quality of hospital economic operation and maintain benign development.The first is to optimize resource allocation and promote the sinking of high-quality resources.The second is to use price levers to promote hierarchical diagnosis.The third is to control human resource cost rationally and promote value creation.The fourth is to promote the refined cost management system and reduce operating costs.6.Use the information monitoring platform to establish a dynamic evaluation system for medical service price.Achieve multi-level and all-round monitoring and evaluation of medical service price,and timely respond to changes in medical service price.Reduce the weakening effect of policy implementation due to regional differences in policy implementation.Establish a dynamic assessment mechanism that is scientific and reasonable,open and transparent in process,multi-party participated in decision-making,and widely accepted by social supervision.7.Build a price risk assessment mechanism to enhance the policy's anti-risk capability.Through scientific price risk assessment process,risk communication can be applied to deal with the crisis,improving the public participation in policy,attaching importance to network public opinion,selecting fair policy evaluation criteria,strengthening internal management to realize price risk minimization and establish policy risk prevention mechanism.8.Introduce third-party evaluation agencies to improve the policy evaluation process and promote the scientific government governance.The establishment of medical service price policy evaluation system process in line with medical reform is an era requirement to improve the government governance system and promote the high-quality development of medical service,and to promote scientific and democratic decision-making.Establish a third-party medical service price policy evaluation process contains accepting the evaluation task,formulating an evaluation plan,collecting information materials,organizing the implementation of the assessment and forming an evaluation report.Innovation and deficiency1.Innovation.(1)This study comprehensively uses quantitative assessment and qualitative analysis methods,taking all public hospitals in Guangdong province as the research object.With large data sample,wide coverage and credible data quality,it is the largest survey and research in Guangdong province up to now.(2)The comprehensive evaluation framework of medical service price policy reform is constructed..It reviews the specific policy documents,research reports and practices of the medical service price reform in public hospitals,analyzes the progress of the reform of medical service price in public hospitals and evaluated the reform effects in terms of current compensation status and economic operation.(3)The study makes an empirical study on the effect of medical service price policy in Guangdong province,applying the difference-in-differences model to evaluate policy effects and overcome the endogenous problems of reform factors.(4)The study incorporates the risk management concept into the evaluation framework and puts forward a risk response strategy.2.Limitation:(1)The implementation time of the medical service price adjustment policy is relatively short,and the possible effects and influences of the policy have not been fully reflected.Some research conclusions need to be further verified.(2)The DID model has corresponding limitations,and the existing policy evaluation methodology cannot completely exclude the influence of related confounding factors.