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Objective:To analyze the cost difference between bilateral surgery and unilateral surgery in the same diagnosis-related group(DRG), and to explore the necessity of coefficient adjustment in DRG payment for bilateral surgery.Methods:The medical record frontpage information of all discharged patients who were divided into FJ25(complicated operation of venous system, without complications and accompanying diseases)by DRG in a tertiary hospital from 2017 to 2019 was selected, and the cost difference between unilateral operation and bilateral operation was compared.Results:A total of 359 patients were included, including 230 patients(64.07%) in unilateral operation group and 129 patients(35.93%) in bilateral operation group. There was no significant difference in gender, age and length of hospital stay between unilateral operation group and bilateral operation group( P>0.05). The hospitalization expenses of the bilateral operation group were higher than those of the unilateral operation group( P<0.05), and the differences mainly came from the expenses of consumables, operation, anesthesia and drugs. There was no significant difference in the expenses of diagnosis and treatment, and the cost of inspection between the two groups( P>0.05). The individual burden of patients with medical insurance in bilateral operation group was higher than that in unilateral operation group. Conclusions:In the same DRG group, the adjustment coefficient can be used to adjust the medical insurance payment for bilateral surgery, so as to avoid the occurrence of clinical decomposition hospitalization behavior.
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Objective To understand the influence of the disease-based hierarchical medical system on inpatients flow covered by the new rural cooperative medical system ( NRCMS) , and that on the funding diversion and medical costs so incurred. Methods One county was selected from the eastern, central and western regions of China respectively, where the disease-based hierarchical medical system has been in place. Policy documents of the three counties were reviewed to analyze such changes as NRCMS inpatients flow, inpatients subsidy diversion, NRCMS fund surplus rate of the current year and medical costs per hospitalization before and after the system was in place. Results A comparison with 2014 found a 1. 26%drop of the out-of-county inpatients of county W of the western region, a 2. 00% increase of township hospitals inpatients of county D in the middle region, and the same ratio of out-of-county and in-county inpatients in county F of the eastern region in 2015. Compared with 2014, the fund surplus rate of county W increased 10. 46%, and the inpatient subsidy ratio of county D decreased 2. 51% for those in out-of-county medical institutions in 2015. Thanks for the quota payment of specific diseases under global budget in county W, the inpatient medical costs per hospitalization dropped at both county and township medical institutions. Conclusions The disease-based hierarchical medical system could optimize the NRCMS inpatients distribution among various medical institutions, conducive for establishment and operation of such a system.
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Objective:To understand the patients'satisfaction on catastrophic medical insurance of New Rural Cooperative Medical Scheme ( NRCMS ) , and provide references for effective management and policy improvement. Methods:According to the principles of representative sampling, a questionnaire survey conducted. 484 patients got compensation for catastrophic insurance in 2013 were surveyed, and information of medical costs was analyzed. Re-sults:The average medical cost accounts for 84. 57% of total household expenditure. Mandatory medical expenditure is still high and economic burden of diseases is heavy. This policy has increased the compensation rate, and the actu-al compensation rate increases 4. 79% in three districts. The average score of patients' attitude toward catastrophic medical insurance is (3.95±1.05) points, 88. 43% of patients continue to participate in medical insurance. Con-clusions and suggestions:Patients' satisfaction on catastrophic medical insurance of NRCMS is high. It is suggested that the existing financing modes should maintain stability in the short term, and the compensatory rate should be im-proved reasonably.
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Objective: To analyze the effects of the catastrophic disease insurance of New Rural Cooperative Med-ical Scheme ( NRCMS) on alleviating the economic burden of patients in Beijing, and evaluate the effect of the policy implementation. Methods: Based on high, middle and low economic development levels and the implementation pro-ceedings of catastrophic disease insurance of NRCMS, this paper selects 3 districts of Beijing, from which it chooses two or three villages and towns with the highest numbers of catastrophic disease patients, in order to understand the opera-tional status quo of the catastrophic disease insurance through in-depth interviews with managers. This paper conducts questionnaire survey among all catastrophic disease patients from the sampled villages and towns, and uses 497 valid questionnaires received to understand patients' subjective feelings and collect relevant data of family income and medical expenditure of catastrophic disease patients in 2013. Then it carries out data docking with the platform of NRCMS man-agement centers and measure the economic burden of catastrophic disease patients. In this paper, quantitative and qualitative data are analyzed using statistical and thematic analyses, respectively. Results: The catastrophic disease in-surance of NRCMS has significantly played an important role in reducing the average medical expenditure of catastroph-ic disease patients and improving the actual compensation ratio in varying degrees. However, the incidence of cata-strophic health expenditures has not significantly improved. Conclusion: This paper suggests to increase deductibles and reimbursement ratios of catastrophic disease insurance in order to broaden reimbursement directory and other initiatives to improve the compensation level and focus on alleviating the economic burden of catastrophic disease patients.
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Objective:To analyze the benefit incidence and evaluate the implementation effects on catastrophic disease insurance under the New Rural Cooperative Medical System ( NRCMS) in Jilin Province and put forward sug-gestions to perfect the catastrophic disease insurance under NRCMS. Method: In-depth interviews with related staff were conducted to gain an understanding of the operating status of catastrophic disease insurance under NRCMS;cat-astrophic disease patient data of Jilin Province from 2013 were collected, with a comparative analysis of implementa-tion effects among nine districts;the benefit incidence was analyzed by means of the Sperman rank correlation analy-sis; Results: The policy of catastrophic disease insurance under the NRCMS exhibited sound implementation effects and played an important role in reducing the economic burden of catastrophic disease patients. The average individual expenditure decreased by 4336. 52 yuan, while the reimbursement rate increased by 11. 15% after NRCMS cata-strophic disease insurance reimbursements. Additionally, statistical analysis results showed that there was a weak cor-relation between benefit incidence and economic level, the benefit equality of catastrophic disease insurance under NRCMS was relatively good, but the benefit level of rich patients was slightly higher. Conclusion:The reimbursement scheme of catastrophic disease insurance under NRCMS should be refined and improved, and the benefit fairness of different districts must be ensured, thus achieving the goal of relieving the“poverty caused by illness” phenomenon.
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Objective:To put forward rational suggestions of how to reduce the protest in medical insurance cases from two aspects:hospitals and medical insurance agencies, to provide reference for strengthen management of designated hospitals and Medical Insurance Center. Methods:Taking a tertiary hospital of Beijing as an example, summarizing the basic situation of protest in medical insurance and analyzing several kinds of cases, making thorough analysis of deep-seated reasons which caused the protest in medical insurance and finally put forward rational suggestions. Results: The protest in medical insurance is not only caused by hospitals, the Medical Insurance Center should also take certain responsibilities. Conclusion: Hospitals and Medical Insurance Center should all take corresponding measures to reduce the protest in medical insurance cases.
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The paper presented the principles and references for identifying services of the primary health care at townships and villages in Beijing, and proposed the screening criteria for primary health care package in rural Beijing. Studies made have identified the screening results for the package applicable to both townships and villages in Beijing, along with analysis for the rationale, applicability and operability of the package. Moreover, it probed into the assurance conditions for offering primary health care as a reference for other regions in the country.
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Objective To study teaching cases of health economics in the context of health reform and development in China.Method Preparing for lessons in groups,information collection,experiences summary,and field research.Result Three productions:a teaching plan,a case collection,and a guideline of case teaching.Discuss It is useful to improving students’ ability to contact theory with practices and enhance teacher’s teaching and researching ability,but it also needs further improvement.