Evaluation Of The Effect On The Reform Of Compensation Mechanism In Public Hospitals

BackgroundSince the launch of the new medical reform in China in 2009,the reform of public hospitals,as one of the core tasks of the new medical reform,has been marked as the deep water area of the reform.In September 2017,the drug bonus was completely abolished and the medical service price was adjusted,on behalf of a notable progress in the reform of public hospitals.The 63-year drug bonus policy was formally withdrawn from the historical stage,and the zero plus drug rate incident became a milestone in the new medical reform,but it was all around solving the problem of"it is difficult to see a doctor and the cost of seeing a doctor",in an all-round way.At present,there are still some contradictions and problems to be solved in the reform of medical and health system.In Guangzhou,since the implementation of the one-year policy of abolishing the drug bonus and adjusting the medical service price in Guangzhou on July 15,there have been great differences in the contents,time schedule and effectiveness of the relevant policies in various regions.It is necessary to follow up and evaluate the implementation of the policy.After the reform of the compensation mechanism,is the medical service price compensation and financial special compensation in place?What is the structure of medical service price compensation?What is the operation of the hospital after the reform?Is the hospital efficiency improved?Has the patient's burden changed?In view of the reform complexity,it is urgent to evaluate the effect of policy implementation in combination with the theory and empirical situation of health economic policy evaluation.ObjectiveBased on the relevant original data before and after the reform of sample hospitals,this study analyzes the public hospitals' compensation situation after the implementation of drug zero plus rate and medical service price adjustment policy,compares the changes of medical income and cost,and the change of the proportion of all kinds of income.The data enveloping method is used to analyze the efficiency of the sample hospital,evaluate the initial effect of the policy and the existing problems,and put forward some suggestions for optimizing and improving,so as to provide the accurate basis for the adjustment of the price,and the data envelope method is used to analyze the efficiency of the sample hospital.To provide theoretical and practical support for government decision-making.MethodsThe methods used in this study include literature research method,expert consultation method,questionnaire survey,descriptive statistical analysis,cluster analysis,ratio analysis,data envelopment analysis and structural change analysis.Conclusion(1)The reform of the compensation mechanism has reached the expected target of the policy.Through the reform of compensation mechanism,the public hospitals compensation ways in Guangzhou have been transformed from three channels:drug plus income,medical service charge and financial compensation into two ways:medical service charge and financial subsidy.According to the analysis of one-year compensation after the reform,the overall compensation rate in the first year after the reform is 103.82%,which basically achieved the policy target.(2)There are differences in the types and quantity of compensation for medicalservices in public hospitals.Medical service items are mainly divided into integrated medical services,medical technical diagnosis and treatment,clinical diagnosis and treatment and traditional Chinese medicine and national medical treatment,among which the diagnostic items are the main source of price compensation for medical services in public hospitals.The change of the diagnostic items accounted for 46.55%of the total.In addition,there are still some hospitals have policy losses which are facing challenges.(3)The operation of public hospitals is relatively stable and the income structure is optimized.The drug revenue in Guangzhou accounted for 34.96%getting down 6.14%from the same period a year earlier.The decline was up to 14,93%.The income of medical technology service rose by 4.44%over the same period a year earlier.The income structure of the medical service has been positively adjusted,and the hospital's income structure has been optimized.To some extent,the return of medical personnel's technology and labor value has been realized.(4)Gradually achieve the goal of establishing a hierarchical diagnosis and treatment system and improve the eff-iciency of hospitalization.The number of inpatient services in public hospitals continued to grow steadily,and the number of outpatient visits showed a downward trend compared with previous years.The overall decline was 2.88%,especially for large tertiary hospitals.The number of outpatient visits decreased by 1.546 million.The effect of graded diagnosis and treatment policies was initially revealed.The average number of days of hospitalization for dischargers was 8.57 days,a decrease of 0.31 days from 8.88 days in the same period of the previous year.(5)The growth rate of medical expenses per patient discharged from hospital has slowed down,and the cost structure tends to be reasonable.The average hospitalization expenses of Guangzhou public hospitals during the study period increased by 3.19%year-on-year,which was lower than the increase in the average cost of hospitalization in the province during 2015-2017,which was far below the upper limit of the increase in medical expenses.Among them,the drug fee(excluding Chinese herbal medicine)dropped sharply from the previous year,with a drop of 16.50%;the proportion of expenses reflecting the value of technical labor increased from 23.18%to 28.36%.(6)After the implementation of the policy,the public hospitals smoothly transitioned and the hospital efficiency improved slightly.the comprehensive technical efficiency value of the sample hospital increased from 0.882 to 0.900,and gradually increased to an effective value of l,which was slightly improved compared with that before the reform,but the change was not significant.There were 5 new effective hospitals in 66 sample hospitals,indicating that the hospital efficiency was gradually improved.Hospital technology and scale efficiency results show that most hospitals still have room for improvement in technical efficiency,some hospitals are too large,and medical and health resources need to be further optimized.