A Study On Trendency And Cause Analysis Of Medical Care Cost Growing Rapidly Of A Large-scale Comprehensive Hospital

ObjectiveAnalysis of change tendency of hospitalization charge in some a hospital and the cause of persistent high medical fee in recent yearsAimThe study,by comparing the hospitalization charge data among a large comprehensive hospital in Liaoning province,department-affiliated and province-affiliated medical organization from 2002 to 2006,was to analyze the increase characteristics of hospitalization charge in the hospital and other hospitals in China. According to the descriptive analysis of all patients' hospitalization charge from 1999 to 2007 in the hospital,the study was to find out the fluctuation tendency of hospitalization charge in recent 9 years,analyze the increasing status and causes of medical fee,identify the key problems needed to be solved,and put out suggestions on medical fee control in china.MethodDeep talk:in the course of the study,we talked to epidemiological and clinical doctors many times to understand better and check the composition,the increase characteristics and causes of hospitalization charge.Literatures:we consulted a large quantity of Chinese and English literatures to know the development condition and solution on medical fee control in China and other countries,and use the combination of quantitative and qualitative analysis. Results(1)the hospitalization charge per patient of department-affiliated medical organization was much higher than that of the hospital from 2002 to 2006,the highest altitude was up to 43%;the hospitalization charge per patient of province-affiliated medical organization was also higher than that of the hospital from 2002 to 2005,the highest altitude was 18%,but the two were almost the same in 2006.The hospitalization charge per patient of the hospital was increasing year by year,from RMB5911.6 in 1999 to RMB10254 in 2007.It grew by 73.47%,averagely 8.16%per year.(2)The ratios of drug fee to the total charge in department-affiliated and province-affiliated medical organization were higher than that of the hospital from 2002 to 2006;the ratios of the examination and therapeutic operation fee to the total charge in department-affiliated medical organization were higher than that of the hospital in2002 and 2004,they were the same in 2003,and the former were lower than the latter in 2005 and 2006;the ratios of the examination and therapeutic operation fee to total charge in province-affiliated medical organization were higher than that of the hospital from 2002 to 2004,but lower in 2005 and 2006.(3)The mean charge of each patient and daily bed fee also increased year by year.(4)Among the increase tendency of hospitalization charge in the hospital, examination fee increased fastest.It grew nearly by 10 times,and operation fee,drug fee,and therapeutic fee were the next.(5)Although the ratio of drug fee to total charge exhibited the tendency to increase in recent 9 years,the absolute value of the drug fee per patient didn't decrease. The ratio of operation fee and examination fee to the total charge progressively increased.(6)There are both reasonable and unreasonable factors that cause the increase of the medical fee.The unreasonable factors mainly contained two aspects:one is that the government didn't fulfill its responsibility,the other is that the providers induce the requirement.Conclusion and suggestion:The problem that the providers induce the requirement isn't a simple provision-requirement problem,but a kind of medical service behavior from providers. It's based on different medical health system and changes with the change of the system. At the same time,the behavior that providers induce the requirement is the concentrative reflection of medical health problems.The research to manage it must start with the system,find out the fundament of the problem,then we can find the solution to the problem.The concrete solution and suggestion are as follows:(1)To identify the government's dominant role in the medical system.Public medical treatment and basic medical requirement should mainly depend on the investment of the government;(2)The government should arrange the distribution of the medical service to avoid the medical resource mainly concentrate in developed area,in cities and in territory with top medical service,then to guarantee the accessibility of the medical service.(3)To change the medical service price system that doctors live on drugs.For profitable hospitals,we can introduce the competition system,make the medical service price formed in competition to prevent the market monopol.For unprofitable hospitals, we continue carrying out the rule that the government fix the price or the government leads them to fix a acceptable price.(4)To establish and strengthen the system that makes the medical service information public.Patients have知情权and主动权,then they can go to the hospitals with high technique,good service and low expense.This can promote the equal competition among hospitals.(5)It is recognized that the payment way that we charge according to the items, induces requirement induction,so it's essential to select DRGs in China.In the enforcement of DRGs,the most difficult work is to fix a standard price for a certain disease.The appropriate method is to fix the basic price for a disease based on the diagnostic route and experts' consultation,then use the加权between the basic standard price and mean social price to fix the standard price for a disease.(6)To promote the development of medical accidence-responsibility insurance system,and correct the self-defensive medical behavior.