Empirical Study On The Staged Outcomes Of Medical Price Reform In Public Hospitals In Zhuhai City Under The Policy Of New Medical Reform Of China

Objective: To analyze the changes in the service-quantity,income,structure of income,average cost,and the compensation rate of the public hospitals in two years before(2013&2014)and after(2015&2016)the medical price reform of Zhuhai City,and to study the outcomes of the reform in order to provide the basis for the following reforms.Methods: 1.To establish a database from data collection through the application of the decision-making analysis software Finereport 9.0,and to generate the annual tendency chart of all indexes.2.Comparing the figures of service-quantity and income two years before and after the medical reform of fifteen public hospitals in Zhuhai City by descriptive statistics: figures of 2016 being compared with figures of 2015;figures of 2015 being compared with figures of 2014.3.SPSS18.0 software was used for statistical analysis,and paired t-test was used to compare changes in service data,income,and average cost of public hospitals before and after reform.Results: 1.After the reform,the annual total number average of diagnosis and treatment,and hospital discharges of fifteen public hospitals increased by 527,000 person-time and 48,000 person-time.The annual total number average of diagnosis and treatment of second-class hospitals increased by 583,000 person-time,while it decreased by 56,000 person-time of tertiary hospitals.The annual total number average of hospital discharges of second-class hospitals and tertiary hospitals increased by 18,000 person-time and 30,000 person-time.Compared with 2014,the average hospitalization time of fifteen public hospitals decreased from 8.60 to 8.10 days,while the bed utilization ratio increased from 83.37% to 89.15%.2.After the reform,the annual total number average of specialist-outpatient visits of second-class hospitals and tertiary hospitals increased by 159,000 person-time and 215,000 person-time,reaching to 455,000 person-time and 2,614,000 person-time.The annual total number average of general-outpatient visits in the second-class hospitals increased by 316,000 person-time to 1,196,000 person-time,while it decreased by 210,000 person-time to 1,873,000 person-time in tertiary hospitals.The proportion of specialist-outpatient visits and general-outpatient visits in tertiary hospitals was 59.1% and 40.9%,while it was 27.9% and 72.1% in second-class hospitals.3.In 2016,the occupation rate of medicines in fifteen hospitals decreased by 8.62% to 31.56%,while the proportion of medical income increased by 4.24% to 26.79%,the proportion of inspection income increased by 4.12% to 31.32%,and the proportion of medical consumables income increased by 0.2% to 10.3%,all being compared to those in 2014.The proportion of inspection income in both second-class hospitals and tertiary hospitals exceeded 30%.4.The medical service compensation rate of fifteen hospitals in the first year and the second years after the reform was 82.82% and 79.69%.The medical service compensation rate in tertiary hospitals was 81.22% in 2015 and 77.33% in 2016.In second-class hospitals,the medical service compensation rate was 96.55% in 2015 and 96.77% in 2016.5.After the medical reform,the average cost of outpatient visits and hospitalization in 15 public hospitals increased.In 2016,the growth of the average cost of outpatient visits in 15 hospitals was 0.3%,far lower than the annual growth of CPI(1.9%)in Zhuhai city.Excluding the factor of price increasing,the growth of the average cost of hospitalization in 15 public hospitals(6.4%)exceeded the annual growth of CPI in Zhuhai city,approaching to the level of the average cost of hospitalization in Guangdong Province in 2016.Conclusion:1.After the Medical price reform,the total service-quantity in 15 public hospitals of Zhuhai City increased steadily.2.After the medical price reform,the total number of general-outpatient visits and specialist-outpatient visits of the second-class hospitals increased while the general-outpatient visits in the tertiary hospitals decreased.The trend of outpatient visits moved gradually towards a reasonable direction.3.After the medical price reform,the change of income structure in public hospitals met the expectations,with the proportion of the income of medicines decreased and the proportion of medical income increased.4.After the medical price reform,the growth of medical cost slowed down,and the cost of medicines decreased obviously.However,the effect of the changes mentioned on controlling the total cost was still needed to be observed.5.After the medical price reform,the disparity of medical service compensation rate of fifteen public hospitals were large,and it needs further study to find out whether it is related to the level of management.In conclusion,in the future reform,“the separation of treatment and inspection” should be explored positively,the medicine service fees should be established,the reform of the circulation of medicine consumables should be strongly promoted,all in order to increase the proportion of technical income.The modern hospital management system should be established,and the policy of financial differential compensation should be implemented on the basis of cost accounting.Distribution plans that reflects the value of medical staff should be considered and implemented,and a unified information platform for health,social welfare and hospitals to control fees in real time should be established.The reform of payment methods such as total prepayment and the combination of DRGs diseases should be explored to interact with the reform of medicine price simultaneously,so as to effectively reduce the burden of patients through combination strategy.