The Study On Medicare Cost Containment Strategies And Key Performance Indicators Under The Total Budget System

ObjectiveWith the rapid growth of medical expenses especially the rapid rise in healthinsurance abroad, Government and residents should suffer from the burden of medicalexpenses which is overweight. To alleviate the society’s burden of medical costs’pressure, countries have committed to research health care cost containment strategy. Onthe one hand, our country’s health development is lag, on the other hand, the distributionof resources is uneven. So how to curb the accelerate health development by controllingthe waste of resources, and to gradually reduce the patients’ burden of medical costs atthe same time, is an important subject for our government and medical institutions tosolve.This study uses the theoretical research and empirical research method to explorethe reasonable methods and measures of health care costs control and health conditionswhich is suitable for the development of our country by drawing on mature experiencesand theoretical of controlling health care costs abroad and by absorbing the relatedresearch results of domestic research institutions. On the one hand, medical institutionsare the key to promote the smooth implementation of the health care reform, on the otherhand, health care reform requires medical institutions actively adapt to and develop bythe policy guidance. Therefore, this study is to explore a better quality and efficiencypublic hospital health care costs control strategy by analyzing the effect of the health carecosts control implemented in a grade A tertiary hospital in Shanghai (we christened it "A"hospital) which is under total budget payment system. Besides, we want to form a KPIsystem and the long-term-effective management system by Delphi expert advice. Weexpect to make a contribution to government departments, hospital performancemanagers and hospital workers.Methods1. Literature studyUsing Chinese and foreign journals’ full text databases, and other academicresources, databases and Internet databases to retrieve relevant documents, including thestudy of two aspects: Firstly, through reviewing extensive literatures to summarize themethods of controlling health care costs and its pros and cons. Secondly, through searching literatures and summarizing the evaluation to determine the key performanceindicators.2. Retrospective cohort studyWe evaluate the effect of the medical insurance cost control management measuresby analyzing key indicators before and after “A” hospital implement single diseasecontrol, clinical management and control measures to identify its inadequacies andadvantages.3. Delphi methodWe select15experts: the six grade A public hospitals in each selected two expertsfrom their hospital management experts and performance management experts, medicalinsurance department selected one expert, the other two experts are selected in ShenKangagency which is responsible for hospitals performance evaluation. Inclusion criteria:associate professors and above, work for more than five years in the field of hospitalmanagement or performance management. We form the first round of questionnairesfrom the literatures’ review, discussion groups, and then deliver to experts. Consultantsshould provide feedback and suggestions. Then we determine the re-entry questionnairesin accordance with the first round of expert evaluation. After the second round ofquestionnaire survey, we obtain the final critical examination entries according to thestatistical results. If the results of experts’advices in the second round of the survey havebeen fairly consistent, we can end expert advice, otherwise we should carry out thirdround of consultation. We hide the experts’ information each other so that experts on thecontents of the questionnaire can be free to express their views and suggestions.4. Statistical methodWe use descriptive analysis to observe domestic and international medical services’development status and problems. We use implement non-parametric tests to analyzethe key indicators before and after “A” hospital implement the individualdepartment-based management. We use two independent samples t-test to analyze therange of key indicators before and after “A” hospital implement single diseases’ qualitymanagement, clinical path management and to evaluate its cost control effect.Results1. Medicare cost control strategies implemented abroad have achieved someeffectiveness, whatever, many countries are still in an unreasonable medical expensesgrowing trend. Because of the different backgrounds, the advanced theories and methodologies abroad is not suitable for our country.2. The health care expenses and the distribution of health resources in our countryare not reasonable which cause “difficulty and costliness for medical service” and"drug-maintaining-medicine"3. The individual department-based management suppresses the growth of Medicareoutpatients’ costs to a certain extent, but we can not consider that it could suppress thegrowth of inpatients’ health care costs. The decompose method for the costs index byindividual department-based management is reasonable for outpatient service but notreasonable for inpatient service.4. After implementing of single diseases’ quality management, six single diseases’hospital costs decreased significantly compared with before implementation in “A”hospital, the ranges of the length of stay and diverse costs are different between variousdiseases.5. We have determined some key performance indicators credibility after tworounds of expert consultation. And finally present3fist level indicators,10second levelindicators,27third level indicators.Conclusions1. Although the theory and methods to control health care costs in developedcountries is worth learning, however, various methods have their drawbacks which cannot be ignored, and therefore on the one hand, China should actively explore andimplement measures suitable for China’s current status for controlling the development ofmedical and health services costs, on the other hand, it should lay the foundation for theintroduction of advanced medical costs management approach and actively carry outpreliminary studies and preparatory work.2. The individual department-based management is an extensive management whichshould combine with sophisticated cost management methods such as single diseases’quality management, clinical path management, performance appraisal and management,but it can not be replaced. So the scholars should be engaged in exploring scientific andeffective health care costs allocation scheme.3. The insurance regulatory agencies should expand the coverage of diseases forsingle disease management and clinical path management, and explore methods of costcontrol by single diseases.4. Under the situation of the new health care reform, hospitals should seize the opportunity to adapt to the reform-oriented health care development and explore hospitalKPI system to form the a long-term mechanism for controlling health care costs.