Construction And Empirical Study Of The Index System For Monitoring And Evaluating The Dynamic Adjustment Of Medical Service Price

ObjectivesThe purpose of this study is to build a set of perfect and effective monitoring and evaluation indexes for the dynamic adjustment of medical service prices and set the trigger conditions for the monitoring indexes for the dynamic adjustment of medical service prices.In order to solve the problems such as unreasonable setting of starting conditions and constraint conditions of dynamic adjustment of medical service price,untimely price adjustment,unreasonable adjustment space,unscientific selection of adjustment items and adjustment range,and straighten out the price comparison relationship of various medical service items.Through the empirical study,we can learn whether the price adjustment of medical services in selected provinces is timely and reasonable,whether it responds to the price adjustment of medical services,further verify the effectiveness and scientific feasibility of the index system,and provide technical support for the dynamic adjustment of medical service prices,in order to establish a sensitive and orderly mechanism of dynamic price adjustment.Contents(1)Define the concept of dynamic price adjustment monitoring of medical service items.(2)Use Delphi method and analytic hierarchy process to construct the index system of monitoring and evaluating the dynamic adjustment of medical service price.(3)Study the setting of trigger mechanism of monitoring and evaluation index of dynamic adjustment of medical service price.(4)Select the five-year span data of five provinces(municipalities)from 2017 to 2022,according to the established index system and trigger mechanism,and conduct an empirical study on the dynamic adjustment monitoring of medical service prices.Methods(1)Literature research method:subject words and keywords were used to search the databases of CNKI,Wanfang,web of science and PubMed,as well as the websites of The State Council and health administration departments,to obtain literature content and policy documents related to the dynamic adjustment of medical service prices,and to comb out the concept,connotation and theory of the dynamic adjustment and monitoring of medical service prices;Retrieve the national regulation requirements of specific indicators and related documents related to indicators,and set reference values in the trigger mechanism.(2)Expert interview method:Interviews were conducted with medical service price managers of medical insurance departments,hospital price personnel and medical insurance department personnel,including the framework of monitoring and evaluation index system of dynamic adjustment of medical service prices,inclusion and exclusion of indicators,etc.(3)Delphi method:Draft the index system on the basis of literature research,use Delphi method for expert correspondence consultation,and obtain a scientific and reliable index system for monitoring and evaluating the dynamic adjustment of medical service prices.(4)Analytic hierarchy Process(AHP):The analytic hierarchy process(AHP)with subjective weighting is adopted,and the weighting coefficient is determined by the consulting experts according to their experience in the research content and the relative importance of the research to the indicators.(5)Empirical analysis:To evaluate the scientificity and feasibility of the index system by selecting the data of individual provinces for empirical research on the index system.Results(1)This study has defined the connotation of research objects such as dynamic adjustment of medical service price,dynamic adjustment monitoring and dynamic adjustment trigger mechanism.(2)In this study,a draft monitoring and evaluation index system including 5 first-level indicators,12 second-level indicators and 23 third-level indicators was preliminarily formulated.Two rounds of expert consultation were conducted.The positive coefficient of the two rounds of expert consultation was 86.95%and 100%,and the expert authority coefficient was 0.86 and 0.92 respectively,both of which were greater than 0.7.In the first round of expert consultation,the expert coordination coefficients of importance and feasibility were all less than 0.300.Finally,a monitoring and evaluation index system of dynamic adjustment of medical service prices was established,including 5 first-level indexes,12 second-level indexes and 22 third-level indexes.The analytic hierarchy process(AHP)was used to calculate the weight of indicators,and the results showed that the weight values of the first-level indicators were 0.1526,0.2954,0.3108,0.1571 and 0.1041,respectively,for the dimensions of social macroeconomic development,medical insurance operation,medical institution development,patient personal burden and medical service cost.Among the secondary indexes,the indexes with relatively high weights are "patient out-of-pocket payment level" "medical income structure" and "medical insurance fund balance" from high to low,with weights of 0.7793,0.6944 and 0.6606.The highest comprehensive weight of the three indexes of the index layer is the number of months that the accumulated balance of the employee’s medical insurance pooling fund can be paid and the number of months that the accumulated balance of the resident’s medical insurance pooling fund can be paid under the balance of the medical insurance fund,which are 0.0940 and 0.1011 respectively.The second highest index is the out-of-pocket proportion of employees within the scope of medical insurance policy and the out-of-pocket proportion of residents within the scope of medical insurance policy at the level of patients’ out-of-pocket payment,which are respectively 0.0586 and 0.0638.The comprehensive weight of three-level indicators under the structure of medical income can be divided into:Medical service income accounted for 0.0823,inspection income accounted for 0.0333,medicine income accounted for 0.0298,health materials income accounted for 0.0328,traditional Chinese medicine service income accounted for 0.0333.On the whole,the results of the research weight value showed that it was in line with the requirements of the pilot program and experts’expectations for price adjustment.When the proportion of medical service income is below a certain reference value,about 40%,price adjustment can be initiated.At the same time,the proportion of drug,monitoring and testing income can be reduced,the unreasonable income structure can be improved and the sound operation of medical institutions can be promoted.(3)Analysis on the current situation of triggering mechanism for dynamic adjustment of medical service prices in various provinces found that:The annual growth rate of medical income,the growth rate of the proportion of medical service income,the growth rate of the average medical cost of outpatients,the growth rate of the average medical cost of inpatients,the annual growth rate of the total medical cost of the previous year,the growth rate of CPI,the balance of the employee basic medical insurance pooling fund and the number of months of the residents’ medical insurance fund balance were set as the indicators of the starting conditions and constraint conditions in most provinces.There are also similarities and differences in the setting of starting and constraining reference values for the same index.Most provinces adopt conditional trigger criteria.The pricing of general medical service items and the adjustment trigger mechanism of complex medical service items are set,which is reasonable and scientific on the whole.(4)Empirical test results The five provinces were selected to score more than 60 points in the first three years and less than 60 points in the next two years.After corresponding trigger criteria,it was found that all the five provinces triggered price adjustment in the first three years,but did not trigger price adjustment in the last two years.In terms of specific index scores and social and macroeconomic development dimensions,most of the scores of the provinces are within the interval value,without triggering start-up and constraint conditions.In terms of medical insurance operation dimension,the score situation is basically the same,without triggering start-up and constraint conditions;From the perspective of the development of medical institutions,the scores of the proportion of medical service income,which is important to influence price adjustment,are all under the starting condition,and the proportion of check income is inconsistent.The proportion of drug income is less than 30%of the starting value,triggering the starting condition,and the proportion of health material income is less than 30%of the starting value,triggering the starting condition.In terms of the patient’s personal burden dimension,the out-of-pocket ratio values of employees and residents within the scope of medical insurance policies in 5 provinces(municipalities)were all within the interval value,without triggering and constraint.In terms of the dimension of medical service cost,the ratio of personnel expenditure to total expenditure in only one province is in the starting range,and the rest are in the restricted range..Conclusions(1)The scientific and feasible monitoring and evaluation index system of dynamic adjustment of medical service price constructed in this study has a scientific structure and abundant items,including 5 first-level indicators,12 second-level indicators and 22 third-level indicators.The expert experience of analytic hierarchy process(AHP)was used to obtain the weight estimate of the index,and it was found that the evaluation of service price adjustment should focus on two aspects:medical security and patient’s personal burden.(2)In terms of the status quo of setting trigger conditions of monitoring and evaluation indexes for dynamic adjustment of medical service prices,it is found that many provinces have issued relevant documents and set trigger standards.On this basis,according to the constructed monitoring and evaluation index system for dynamic adjustment of medical service prices,The start-up conditions and constraints of general medical service items and complex medical service items are reasonable,and the trigger criteria and adjustment assessment cycle are realistic.(4)An empirical study was carried out with the help of monitoring and evaluation index system and trigger mechanism.The evaluation results of medical service price adjustment in 5 provinces from 2017 to 2022 side verified the effectiveness of medical service price adjustment after price adjustment in accordance with policy documents in various provinces,and also verified the scientific and feasibility of establishing the index system and trigger mechanism in this study.Advice(1)Further improve the monitoring and evaluation index system and trigger mechanism.(2)Use information technology to help the dynamic adjustment and monitoring of medical service prices.(3)Problems found in scientific application evaluation guide the next round of adjustment and reform.(4)Increase the participation of all subjects in monitoring and evaluation,and evaluate price adjustment from multiple angles.(5)Strengthen the response to the dynamic adjustment of medical service prices in public hospitals.