The Study Of Pricing Model About Disease Based On Cost

BackgroundMedical institutions had been always taking the way of paying by medical service projects for a long time in our country. With the changing conditions, our social economic development had been translated planned economy into a market economy, according to the project payment and control the growth of medical costs were incompatible, and with the norms of medical hospitals and doctors were not in harmony. Project payment was the direct and main reason for hot social issues about "difficult and expensive" and "poverty caused by illness". Under this payment, the medical expenses were closely related to the number of health care services, would induce excessive medical institutions to provide medical services and compete introduction of sophisticated diagnostic equipment, resulting in higher fees for project services, a waste of medical resources.Therefore, developed countries had been to carry the medicare payment reform, to develop fully into account the patient’s medical institutions, medical expenses and other multi-equity price system, the DRGs become the first choice. DRGs way to show income for medical institutions and diagnosis of each case only, but not with medical treatment unrelated to the actual cost of the spent cases, medical units and thus avoided misuse of medical services, duplicate items and decomposition project, and also ensured the quality of medical services.China in recent years carried out DRGs reforms, intended to encourage medical institutions to establish cost constraint mechanisms that regulate the behavior of clinical diagnosis and treatment of medical institutions to improve the quality and efficiency of medical services, a reasonable allocation of health care resources, reduce health care costs, thus effectively reducing the patient’s medical expenses. But the implementation of DRGs in China is still in the exploratory stage, especially in the conduct of the disease process of price regulation, the price department provinces and cities were generally encountered difficulties in the theory and operability. For example, the standard of DRGs how to determine, the DRGs based on what, how to price both to ensure that patients enjoy a high quality and low cost services, but also enable healthcare service providers to get reasonable compensation, there are no uniform, specification, reference standards. Meanwhile, the pricing in the pilot areas by disease took a direct government in the form of pricing and price-cap regulation diseases prices, there are some flaws.Therefore, price regulation departments need to develop a method of pricing disease, a scientific research, actionable disease pricing ideas, methods and models, these are the key to DRGs reform implementation.SignificanceThis study is in the original project "Research disease costs and expenses (first, second, three batches) in Guangdong Province" in research on diseases cost accounting system, based on the average cost to build community-based disease, technical difficulty, risk degree of disease secondary variable pricing model and empirical testing and adjustment, scientific evaluation model, reasonable and feasible, provide pricing basis for DRGs pay (income) expenses manner. To promote health care reform payment system in our province, as well as provide the theoretical and methodological for the work of health care by disease pricing reference across the country.Methods1. The method of literature research:Retrieve the whole database with keywords such as Clinical path, DRGs, diseases pricing in CNKI, Springer, Pubmed, database, etc. By finishing and concluding literatures and research materials about Macro-reforms at home and abroad, which were to explore the theoretical basis of the research and the research framework of problem solved.2. The method of expert consultation:By widely asking for the opinion of industry officials, experts and scholars, we defined and made further discussion on the disease classification and the main operating projects at the angle of the cost of disease and cost management. Master the content of disease cost and health service projects specific fee with through to collecting, sorting and analysis medical services of all kinds of information, and that gave an assignment and evaluation to the affect of parameters about disease to the price.3. Sampling method:sample hospitals sampling is designed to meet the authenticity of this study, conducted a representative sampling; Case sampling is the use of cluster sampling method, in all cases in accordance with the classification systems of different diseases, further systematic sampling disease; disease sampling is a typical sampling of reference.4. Descriptive analysis:general statistical description of the sample fee information Disease Hospital, to carry out a wide selection of clinical path clearer surgical diseases, the use of Excel software to model, build diseases pricing model.5. Empirical analysis:the model A, B, C estimates of disease rates and disease actual price comparison sample hospitals to analyze the differences between the two, select the best model. Then select disease actual price and the best model of a dimethyl hospital in Shenzhen will be the practicality test.Results1. Construction of model results. By anglicizing theoretical and related factors in this study, to constructe with the cost of disease-based, technical difficulty, risk adjusted pricing model for the disease variables, P=(1+Mi×Ki) ×Ci, where:Ci is the social average cost of disease i; Mi=(Hi-H0)/Hi, the human cost of disease samples and the difference between the disease and the human cost of the sample ratio benchmark disease labor costs; Ki for technology and risk adjustment factor. Given the choice baseline disease and formulas Ki has an important influence on the model established in this study take A, B and C are three models to compare the differences, select the optimal model. Note:i is the sample code to be priced disease,0 represents the baseline disease; C is the social average cost of diseases, H is the human cost of disease, T is the main technical difficulty of the operation of diseas, R is the risk extent of main operation of disease, P is the standard disease price of the model estimates.2. Model calculations and validation results. From the selected 15 diseases empirical results,① Model A:The estimated cost price of the standard model with the selected diseases of the basic approach, the difference in the range of [-3.25%,16.94%] interval; and the actual price of the sample mean hospital phase ratio, the difference in the range of [-10.09%,12.84%] interval, volatility of 22.93%, in which the difference in the range of [-10.00%,10.00%] disease interval has 12, indicates that the model a portion of the top three hospitals in Guangzhou adaptability better.② Model B:model estimates the price of a standard higher than the selected diseases in 14 disease costs (except for varicose veins-the great saphenous vein ligation and endarterectomy outside), the difference in the range of [-3.03%,17.33%] interval; compared with the actual price of the average sample hospitals, the difference in the range of [-10.70%,12.54%] interval, volatility of 23.24%, in which the difference in the range of [-10.00%,10.00%] disease has nine sections, indicating that the model B on part of the top three hospitals in Guangzhou poor adaptability. ③ Model C:model estimates the price of a standard higher than the selected diseases in 14 disease costs (in addition to the natural clinical vaginal delivery-a single child birth deliveries outside), the difference in the range of [-4.69%,32.99%] interval; and sample hospitals the actual price of the average compared to the magnitude of the difference in [-24.74%,12.54%] interval, volatility of 37.28%, in which the difference in the range of [-10.00%,10.00%] disease has nine sections, indicating that part of the model C on the Guangzhou area three hospitals poor adaptability.Thus, the three model established in order adaptive optimal model A.3. Model practicality test results. A is the best model by the practicality test showed that the model estimates the price of the standard and the actual price of a dimethyl hospital Shenzhen magnitude of the mean difference in [-116.30%,6.92%] interval, fluctuations mean -32.74%, of which the magnitude of the difference in [-10.00%,10.00%] disease interval has five; higher than the actual prices mean there is 13, lower than the actual price mean there are two. The results show that the model A on the Shenzhen area of a dimethyl hospital also has a certain flexibility.Research and discussion1. Follow the "value determines the price" of principles of economics, select multiple clinical, diagnostic and surgical practices more uniform, the smaller the cost variation based on a variable disease, but can be more objectively reflect the introduction of auxiliary variables medical personnel and technical value of labor Construction disease pricing model. In this study, chronic tonsillitis-tonsillectomy as a benchmark disease, the introduction of technical difficulty, the degree of risk for the auxiliary variables, disease pricing model to build the ultimate mathematical form: Pi=f(Hi,Ci, Ti, Ri)=(1+Mi×Ki)×CiBy building the model and test, this study accurately established the relationship between disease cost and price, In order to promote the medical payment system reform in our province, at the same time according to the pricing provide the theory and method for reference to carry out the national health service.2. This study established a model A, B, C, Price Standard and disease costs estimates, the actual sample hospitals want to compare prices, the best adaptation of model A. Model is measured by a theoretical price and the selected sample 3 armour hospital 15 samples disease roughly tallying with the actual price, show that the model has good adaptability on the 3 armour hospital pricing, at the same time, based on the samples of dimethyl hospital disease level verification, the model also has certain adaptability. Model can be used as a press disease pricing method for reference.3. In order to ensure scientific, normative and maneuverability, for the influencing factors of disease to pricing, can adopt the following strategies:(1) Unified diseases cost accounting systems, and scientifically and standard measure the social average cost; (2) make the disease price adjusted periodically establish mechanisms to ensure that the service price fluctuate around the service value changes; (3) the establishment of multiple composite price system of medical services to meet the multi-level, diversified healthcare needs.Innovations1. We made diseases cost as basic of the diseases price. It is reflecting the essence of medical service price.2. We introduced the risk degree coefficient and technical difficulty coefficient, that could reflect the value of medical service.3. To build a new disease pricing model and make the empirical test at the same time. This could raise feasibility and rationality.