A Study On Influence Of Global Budget On Quality, Efifciency, Costs Of Hospital Services

ObjectivesThrough analyzing relevant indices of the quantity of medical services,efficiency in allocation of hospital beds, efficiency in human resources, and costs ofmedical services in Shanghai’s Grade III hospitals as a whole and various Grade IIIhospitals, before and after the implementation of the Global Budget from2008to2012, this thesis mainly presents issues as follows:First, the thesis discusses the status quo and problems in the present paymentsystem of health insurance funds in Shanghai, and appraises the influence of theimplementation of the Global Budget on the quantity, efficiency, and costs of medicalservices in hospitals.Second, by contrast, the thesis analyses the general changes in relevant indicesbefore and after the implementation of the Global Budget on the quantity, efficiency,and costs of medical services in certain Grade III Level-A comprehensive hospital inShanghai (a sample hospital in the study).Third, the thesis collects detailed data on the sample hospital’s outpatients,inpatients, and inpatients with single disease, and conducts an all-round substantiatedstudy on the amount of patients accepted by the sample hospital, the amount ofexaminations and tests required by the hospital for patients with health insurance andthose at their own expenses respectively, as well as all fees for categorized medicalservices, before and after the implementation of the Global Budget, and discusses theoverall influences of the Global Budget on the quality, efficiency, and costs ofhospital services.The purpose of this present study is to provide theoretical references and actualsurvey results for the government in formulating more preferable examinations onperformance, which can both help to control the costs of medical services andguarantee quality and efficiency in medical services, in a bid to offer constructivesuggestions for strengthening the reform on Shanghai’s medical system.MethodsMethods of this thesis are as follows:(1) It adopts data studies to learn about the status quo of the Global Budge athome and abroad, and in Shanghai, as well as the principles in selecting indices such-4- as quality, efficiency, and costs of medical services in hospitals, in order to guide thestudies of this thesis.(2) This thesis enters relevant information in report forms with Microsoft OfficeExcel2010, and establishes a data base.(3) With the help of SPSS21.0, this thesis conducts a descriptive statisticanalysis on changes of indices such as Shanghai Grade III hospitals’ business quantity,efficiency in medical services, costs of medical services, costs of health insurance,and total costs of medical insurance controlled, before and after the implementation ofthe Global Budget.(4) Based on the analysis on relevant data about the outpatients and inpatients,and detailed data on inpatients with single diseases in17categories in the sampleGrade III hospital in Shanghai, this thesis, by building an regression model of paneldata with the statistics software of STATA, analyses the influence of theimplementation of the Global Budget, time trend, times of hospital-visiting, andnumber of discharged patients, on the number of patients received by the hospital, theamount of common and thorough examinations and tests respectively prescribed forpatients insured and those at their own expenses, as well as all medical service feesfor issues such as drug, examination, treatment, hospitalization, test, and operationmaterial.ContentsMajor contents of this thesis include:(1) The status quo of studies on the Global Budget both at home and abroad.(2) The analysis on relevant changes of indices of the quantity of medicalservices, efficiency in allocation of hospital beds, efficiency in human resources, andcosts of medical services, as well as insured costs and total costs of medical insurancecontrolled in Shanghai’s Grade III hospitals as a whole and3types of hospitals ofcomprehensive hospitals, hospitals featured with Traditional Chinese Medicine, andother specialized hospitals, before and after the implementation of the Global Budgetfrom2008to2012, in a bid to discuss the status quo and problems in the presentpayment system of the Global Budget in Shanghai, and appraises the influence of theimplementation of the Global Budget on the quantity, efficiency, and costs of medicalservices in hospitals. (3) The contrast analysis on the general changes in relevant indices before andafter the implementation of the Global Budget on the quantity, efficiency, and costs ofmedical services in certain Grade III Level-A comprehensive hospital in Shanghai (asample hospital in the study).(4) Detailed data on the sample hospital’s outpatients, inpatients, and inpatientswith single disease, and conducts an all-round substantiated study on the amount ofpatients accepted by the sample hospital, the amount of examinations and testsrequired by the hospital for patients with health insurance and those at their ownexpenses respectively, as well as all fees for categorized medical services, before andafter the implementation of the Global Budget.(5) On the basis of the aforesaid researches, conducting an in-depth analysis oneffects and problems of Shanghai’s implementation of the Global Budget,summarizing experience in the implementation of the Global Budget, and pointing outsome existent problems, as well as putting forward some policy suggestions forbettering the Global Budget.ResultsUpon investigation, the effects of the Global Budget in Shanghai are as follows:(1) Control over medical costs has been strengthened. According to the statisticsof Grade III hospitals in Shanghai, remarkable achievements have been made forcontrol over medical costs after the implementation of the Global Budget. Comparedwith the growth rate of total costs of medical services before the implementation ofthe Global Budget in2008and2009, which were respectively22.15%and22.13%,control over total medical costs in recent years has been strengthened, with the totalmedical costs in2012only increasing by12.63%. Through an analysis on relevantdata on the outpatients and inpatients, and detailed data on inpatients with singlediseases in17categories in the sample Grade III hospital in Shanghai, it is also foundthat costs for examinations and treatments for outpatients and inpatients, and allmedical costs of drugs in the insurance plan have been steadily decreasing after theimplementation of the Global Budget.(2) Quality and efficiency of medical services are improving. Statistics show that,from2008to2012, the business amount in terms of number of outpatients andemergency cases, patients discharged, and inpatients receiving operations increasedrapidly in almost all Grade III hospitals in Shanghai. In addition, efficiency in human resources and beds in Shanghai’s Grade III hospitals went up constantly. Since thepilot implementation of the Global Budget in2010, with the improvement ofmanagement level and service efficiency in hospitals, the efficiency in the use of bedsin Grade III hospitals in Shanghai has also enhanced, with the average hospitalizationduration dropping4days in total, and bed change times of inpatients increasing13.72times in total from2008to2012.(3) Drug proportion is under control. In2008, the drug proportion in Grade IIIhospitals in Shanghai was47.81%, with that of2012being43.3%. Besides, drugproportion in comprehensive hospitals in Shanghai also dropped year by year, whilethis figure was higher than45%before the implementation of the Global Budget, thatof2012went down to40.68%.However, there are some problems in the implementation of the Global Budgetas follows:(1) It is difficult to specify a reasonable total sum for the annual budget.According to the statistics of Shanghai’s Grade III hospitals, Since the implementationof the Global Budget in2010, the total annual verified volume of health insurance andthat for drugs in Shanghai’s Grade III hospitals are increasing rapidly, of which theactual total amount in health insurance is higher than100%of the total verified sumannually, with the actual total sum of health insurance seeing overspending each year.In2012, a total of RMB265million was overspent, which far exceeded the budget.(2) Some medical institutes became unwilling to provide quality services forpatients. According to data from certain Grade III Level-A hospital, compared withpatients at their own costs, obviously fewer discharged cases and examinations wererecorded among patients in the Global Budget. Judging from the trends of theproportion of CD type and major (or critical) operations of the sample hospital, afterthe implementation of the Global Budget, the year-on-year decrease of the proportionof CD type were far greater than that of patients at their own expenses, with the sameresult found in the proportion of major (or critical) operations for patients insured.This means, after the implementation of the Global Budget, the hospital reducedservices such as major (or critical) operations for patients with health insurance, aswell as lowered its service standards for patients in this group, so that it may sparecosts of medical services, to the detriment of some patients insured.(3) Medical institutes tend to treat patients insured by offering consultations inmore sessions, thus impairing treatment effects. Due to the specialty of the trade of medical services, information asymmetry is just common between doctors andpatients. As a result, doctors may take this advantage to ask patients to pay more visitsto the hospital, in order to maintain a certain level of service fee from the outpatientservices on average. This is shown in insured patients’ increasingly higher revisits ratethan that of the patients at their own costs in the Grade III Level-A hospital, with thisrate of the former higher than that of the latter by over3%annually. This change, incontrast, demonstrates that, insured outpatients in the Global Budget need to pay morevisits to the hospital than outpatients at their own costs in the outpatient department ofthe hospital.ConclusionsBased on the aforesaid research, this thesis puts forward the followingsuggestions:(1) To improve the scheme on the Global Budget, and fixing a more reasonablesum of budget.(2) A sound communication mechanism should be promoted between healthinsurance related authorities and medical institutes.(3) Relevant health administrative departments should strengthen regulation toensure service quality for insured patients.(4) DRGs payment under the Global Budget should be established in due course.