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Objective: To analyze the change in community first diagnosis and two-way referral rate under the condition of the regional longitudinal medical consortium implementation in the country at large. According to the simulation results,some suggestions for hierarchical medical system were put forward. Methods : The community first diagnosis and two-way referral rates were determined using the literature meta-analysis, and were simulated under different conditions by means of the system dynamics. Results :The analysis results confirmed that simply increasing the financial subsidies can increase the community first diagnosis rate within a range from 0.08％ to 0. 17％. For in case increases are made by the government in technical financial input to enhance the technical level of the community health service centers and in compensatory financial input to reduce the higher hospitals dependence on the light disease, results showed that the lower conversion rate increased within the range of 0.33％～0.45％ in terms of the two-way referral rating. On the contrary, when technical financial input is increased to improve the technical level of community health service centers, the rate of change was in the range of 7.52％ '- 12.61％ - Conclusions : Firstly, the diversified strategy should be used to promote the achievement of graded diagnosis and treatment. Secondly, the Health Commission plays a key role in the promotion of themedical consortiumconstruction. Thirdly, medical insurance reimbursement differential strategy should be implemented and the supply-side reform should be strengthened. At last,attention should be paid to the rational development of existing referrals, especially the upper and lower ones.
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Objective To study the tendency of per diem expense and drug cost ratio of inpatients with chronic kidney disease (CKD) and the top three diseases (chronic renal failure, nephrotic syndrome, and primary glomerulonephritis) in a tertiary referral hospital in Shanghai from 2011 to 2016, so as to predict the per diem expense and drug cost ratio of inpatients in 2017. Methods We analyzed the per diem expense, drug cost ratio and other general situation of inpatients with CKD, and conducted the modeling research by the expert modeler in SPSS 23.0 software time series analysis module. Firstly, the per diem expense and drug cost ratio of inpatients with CKD from Jan. 2011 to Dec. 2015 were used to build model, and then the per diem expense and drug cost ratio of the inpatients in 2016 predicted by the model were compared with the real data of the inpatients in 2016 and the values of the model were evaluated. Secondly, the per diem expense and drug cost ratio of inpatients with CKD in 2017 were predicted. Finally, according to the same principle, the per diem expense and drug cost ratio of inpatients with chronic renal failure, nephrotic syndrome and primary glomerulonephritis in 2017 were predicted. Results The per diem expense, per capita hospitalization expense and per capita drug expense of inpatients with CKD increased annually from 2011 to 2016, and the expenses were (1 506.89±1 003.34) yuan, 8 252.51 yuan and 2 009.88 yuan in 2016, respectively, with the growth rates being 62.38%, 41.62% and 14.44%, respectively. The drug cost ratio of the inpatients decreased annually, and the ratio reached 32.33% in 2016. The time series models established by the per diem expense and drug cost ratio of inpatients with CKD were Winters additive model and simple seasonal model, respectively. According to the time series model, the predicted per diem expense and drug cost ratio in 2016 were consistent with the real values in 2016. The per diem expense and drug cost ratio of inpatients with CKD in 2017 predicted by the time series model were about 1 600 yuan and 30%, respectively. The predicted per diem expenses of inpatients with chronic renal failure, nephrotic syndrome and primary glomerulonephritis in 2017 were about 1 700 yuan, 1 800 yuan and 1 600 yuan, respectively, and the predicted drug cost ratios were about 30%, 35% and 10%, respectively. Conclusion The hospital income structure is constantly optimized, and a real-time disease cost monitoring information platform should be established. The research based on the trend of single disease expense needs to be further studied.
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Objective To analyze the demographic information and related costs of inpatients with chronic kidney disease (CKD) in a tertiary referral hospital in Shanghai from 2011 to 2016, so as to provide reference for further understanding and improving the current situation of medical treatment of patients with CKD in Shanghai. Methods We retrospectively reviewed the clinical data (age, gender, hospital stay, disease diagnosis, hospitalization expenses and so on) of inpatients with CKD in a tertiary referral hospital in Shanghai from 2011 to 2016. The general characteristics and disease diagnosis of the inpatients with CKD were statistically analyzed by calculating the proportion of each index using a simple statistical description method. The treatment, hospitalization expenses of the inpatients with CKD were compared between different groups by variance analysis and non-parametric test. Results The percent of inpatients from Jiangsu, Zhejiang, Anhui and Jiangxi provinces around Shanghai was 49.97% (10 033/20 079), surpassing that of inpatients from Shanghai (38.78%, 7 787/20 079). The proportion of inpatients with chronic renal failure was the highest (51.98%, 10 438/20 079), and more young people tended to suffer from the disease. The per capita hospitalization expense was increased annually, and the median hospitalization expense was 8 252.51 yuan in 2016. There were significant differences in per capita hospitalization expenses between the different year groups (P0.001). Conclusion Active and effective measures should be taken to deal with the problem of large numbers of nonlocal patients seeking medical services in Shanghai. It is necessary to popularize the knowledge about CKD in young people, and reduce the social and personal losses due to the illness. The economic burden caused by CKD needs to be further studied.
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Objective:To compare and analyze the choice and application of policy tools in the construction of hierarchical medical system in different provinces of china, and to provide advice for improving the effectiveness of the hierarchical medical policy implementation. Methods:Retrieve the policy documents of provincial governments on hierarchical medical policy through internet search;sort names and categories of policy tools based on the classifica-tion of policy tools by Rothwell&Zegveld after consulting the expert,and analyze the use of policy tools by calculating the frequency of different policy tools. Results:This study has summed up 15 types of policy tools in 3 categories in-cluding demand,supply,and environment of provincial hierarchical medical policy. Supply policy tools accounted for 32.92%,demand policy tools accounted for 20.58%, and environmental policy tools accounted for 46.50%. The most widely used policy tool is the regulatory control, and the least used policy tool is the disease catalog. Conclu-sions:Among the choice of policy tools,the category of environmental policy tools are the most widely used,and de-mand policy tools are applied the least. The use of three types of policy tools in the eastern region are balanced,the demand policy tools in Central China are relatively few, and the environmental policy tools are widely used in the western region,while the demand oriented policy tools are scarce.