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Objective@#To learn the impact of abolishing medicine markups on the revenue structure of public hospitals in Qingdao city.@*Methods@#The business performance of 12 public hospitals directly under the Qingdao Health and Family Planning Commission was analyzed to compare their revenue structure the year before (July 2015 to June 2016) and the year since the reform (July 2016 to June 2017).@*Results@#The reform has witnessed increased government subsidies, and decreased revenue from drugs and healthcare materials. For example, the proportion of drug expenditure decreased from 44.21% to 32.71%, while the proportion of medical service income and that of examination and laboratory examination increased to some extent.@*Conclusions@#Given the initial success of the reform, challenges remain in further curbing revenues from examinations and checkups, and growing revenue from TCM drugs as well.
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Based on an analysis of the compensation policy and its problems of the primary medical and health institutions, this paper put forward the corresponding reform framework in Zhejiang province. It proposed to change the compensation policy of " predefining revenue and expenditure, subsidizing its gap after performance appraisal" into " a mixed system of special subsidy and pay for performance". Related policies were also described including governmental functions, special subsidies for input-based payments, classified payments for output services, precautions against financial risks, etc. This paper also suggested that we focus on dealing with the six pairs of balance, such as that between subsidy for the supply and demand sides, and that between internal market and external market.
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OBJECTIVE:To provide reference for developing zero-profit drug policy and compensation mechanism better in ur-ban public hospitals. METHODS:Taking a public hospital in a city as an example,effects of zero-profit drug policy on hospitals, patients,health insurance fund and single diseases with different drug proportions [cataract (2.94%) vs. chronic renal failure (38.77%)] were investigated by analyzing the canceled drug addition costs and adjusted medical service price data after developing zero-profit drug policy. RESULTS:After developing zero-profit drug policy,the overall compensation rate in the public hospital was 95.20%. The overall burden of urban patients was reduced,average burden cost was decreased 197.73 yuan every time;while the overall burden of urban and rural residents had increased,average burden cost was increased 17.39 yuan every time;and the overall burden of all patients had decreased. Health insurance fund had decreased,in which,the urban workers were decreased 151185500 yuan,and urban and rural residents were increased 4550400 yuan. In medical insurance for urban workers and health insurance for urban and rural residents,hospital increased by 7.00% and 8.99% in income in the treatment of cataract,the medical insurance fund increased by 12.07% and 13.67%,and patients'burden increased by 0.58% and 3.43%,respectively. For chronic renal failure,hospital income increased by 3.23% and 3.93%,medical insurance fund decreased by 3.19% and 3.96%,and pa-tients'burden decreased by 4.27% and 3.63%,respectively. CONCLUSIONS:Zero-profit drug policy is the ideal measure for get-ting rid of"drug-maintaining-medicine". When developing the policy,it should be combined with actual situation and different dis-eases to explore adjustment of medical service prices,reasonable financial compensation models and medical insurance payment mechanism.
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Objective To evaluate the traditional Chinese medicine(TCM) output efficiency of the coUnty-level TCM hospitals in Jiangsu Province before and after the reimbursement mechanism reform,and to analyze the factors which affect the efficiency of county-level TCM hospitals.Methods Using DEA to analyze the efficiency of county TCM hospitals,and using the Tobit regression to analyze the influence factors.Results The output efficiency of county-level TCM hospitals in Jiangsu Province is low,and the reimbursement mechanism reform in county-level hospitals of TCM efficiency further decreases;payment model,cost model and revenue model of regression analysis indicate that different factors has different influence on output efficiency of county hospitals of TCM.Conclusion The reimbursement strategy of county-level TCM hospitals should be optimized,the balance of revenue and expenditure structure be adjusted,and the intensity of TCM services reimbursement be increased.
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Objective To discover the operating problems through analysis of the financial situations of the rehabilitation institutions. Methods According to the different regions and different levels of rehabilitation institutions, 416 representative institutions from 26 provinc-es, municipalities and autonomous regions were surveyed. Results 329 effective questionnaires were recalled. 57.75%institutions relied on the superior departments in charge of funding, 51.09%institutions were in breakeven state. They were lack of sustainable development pow-er, and the capital expenditure was mainly used for staff salaries and equipment purchase. Conclusion To solve the shortage of funds in the development of rehabilitation institutions, we should establish a long-term mechanism of internal and external compensation.
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Objective To learn the business operations of the pilot county-level public hospitals chosen for the 2014 experiment,which were subsidized at different levels in the financial subsidy mechanism reform.Methods County-level public hospitals from 109 counties were sampled as pilots from two provinces of the eastern,central and western regions of China.Descriptive analysis and correlation analysis were made to study their business operations at various subsidy levels.Results Proportional differences in the governmental financial subsidy level make a difference in the revenue and expenditure of county-level public hospitals.The higher the subsidy proportion,the lower the annual average of the total workload of the hospital(P <0.01),the less the inpatient expenditure per hospitalization(P =0.01),and the lower the drug proportion as well(P <0.01 ).Conclusions Financial subsidy plays a key role in the financial balance and business operation of such hospitals.Hence the government is proposed to guarantee its financial subsidy responsibility,to build a long-term financial subsidy mechanism.
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The paper summarized the explorations of public hospital pilots in the compensation mechanism and identified the following findings.For example,by means of fiscal support of public hospital infrastructure and development spending,cancellation of drug markup,higher service prices, and reformed payment mode of medical insurance,these hospitals have made initial changes at their business operating mechanism, motivation-guidance of compensation, and their makeup of medical revenue.In addition,such hospitals are found with lower cost of medical care per visit,and higher income of medical workers.The authors also pointed out such problems as inflated drug pricing and expenses,lack of scientific pricing mechanism for medical services,vague definition of policy-related losses,and old-fashioned practice of government investment and health insurance payment.Based on such findings,the paper advised to adjust health care prices by stages and to improve the management of health insurance and the coherence of compensation mechanism.
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According to the target-model of the health care system and characteristics of the health financing system,it is proposed in the paper that the charges of medical services should be the main revenue of public hospital compensation.Efforts should be made to adjust health care service prices and strengthen pharmaceutical management simultaneously so as to rebuild the structure of medical service charge.Medical insurance should make the majority in the compensation to cover most the medical expenses,with government subsidies supporting development.Both government financial investment and medical insurance should join their efforts for planning-guidance and performance-guidance.The authors also suggested to improve a graded and normative diagnoses and treatment system,regulate medical behaviors of public hospitals and their cost standards,justifying the total compensation and standard verification of such hospitals.
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Improving the basic medical and health service system is an important measure to deepen health care reform.Jilin province has explored its unique way of comprehensive reform of the primary organizations in the province by means of reforming grassroots medical operation mechanism and mode of service,and perfecting the compensation mechanism,achieving remarkable results.This article,based on the overall situation of Jilin province,main contradictions and countermeasures research,made detailed analysis of healthcare reform and bottlenecks encountered in the reform.The author pointed out the direction of Jilin province primary medical and health institutions reform,and put forward feasible policy adjustments and suggestions for such a reform.
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Objective To explore the feasibility of various compensation approaches and their combination after canceling the drug addition at municipal public hospitals in Anshan city.Methods 2008~201 1 medical services,balance of payments of Anshan municipal public hospitals during 2008~201 1 were analyzed,to calculate the balance of profit and loss of the hospitals with the drug addition canceled,as well as the effects of various compensation models and their combinations on hospitals’balance,government financial burden,costs of health insurance and patients’out-of-packet costs.Results Without drug addition,hospitals are found with surplus drop,and doubled number of years in deficit.Losses incurred by the canceling can be covered partly by pricing adjustment of medical services or collection of pharmaceutical service surcharge,with complete compensation by collection of medical service surcharge;government financial subsidies for large equipment depreciation or medical services offer part of the compensation,which is affordable by government finance.Such deficits cannot be covered completely by any single approach,yet they can be greatly eased by a combination of the approaches mentioned above.With impacts on all stakeholders in consideration,the optimal solution is the combination of the scheme with adjusted services price plus collection of pharmaceutical service surcharge and medical services compensation.Conclusion With the drug addition policy canceled,the establishment and perfection of the compensation mechanism calls for a synergy of pricing,health insurance and government finance.
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The financial compensation mechanism for public county hospitals are discussed and analyzed in the paper.Such a mechanism is analyzed by means of media coverage and literature consulting,along with field survey.Roadblocks have been found in implementation of the mechanism, namely delayed payment of capital expenditure compensation,poor support for medical equipment purchase,gaps in development key disciplines development,insufficient compensation for retirees expenses,poor definition of policy-incurred losses,and unclear compensation of public health services.in a word,it is imperative to change the unreasonable financial compensation mechanism,before the six financial compensation subsidies can be fully put in place and financial compensation made efficiently.
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According to the theoretical basis of using 5 gripper models of health system reform and high-value policy designing process, to define the over-diagnosis and over-treatment in the process of basic health care utilization in public hospitals of China, basing on the diagnostic framework of the internal and external environment, to explore the causes herein and discriminate the root, direct and intermediate factors that lead to the problem systematically, and identify the formation mechanism of the problem.
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The compensation mechanism reform is the key and difficult point of the public hospital reform.Although current health care reform has been carried out including strengthening public welfare of public hospitals and adjusting the compensation mechanism,the effect is not very obvious.How to conduct the compensation mechanism reform orderly and smoothly has become an important topic.I have analyzed the historical evolution,the status and problems of the hospital compensation mechanism.On the basis I have made views and suggestions about the current drive and the path optimization for the compensation mechanism reform.
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Objective: To analyze the influences of implementing essential medicine system on primary medical institutions and give suggestions. Methods: Using system dynamics method to construct the compensation mechanism model for primary medical institutions. Compare the growth in revenue and expenditure of primary medical institutions before and after essential medicine system implementation. Results: After the implement of essential medicine system, the growth in total expenditure and total income of primary medical institutions is steadier; when the annual growth rate of government financial subsidies invested more than 13%, the growth in total receipts will keep balance. Conclusion: It’s better to guarantee the government financial subsidies invested in time, raise medical service price properly and establish comprehensive compensation mechanism for implementing compensation mechanism of primary medical institutions.
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The drug zero-profit reform in place has changed the compensation channels for China's public hospitals at the county level.In view of this situation,the paper probed into the present landscape of the compensation mechanism at such hospitals.The authors analyzed five compensation channels,i.e.,the special government budget subsidy,adjustment of medical service charges and rates,health insurance payment,social financing,and income/expenditure management.The study aimed at providing policy proposals and references for sustainable reform at such hospitals.
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Given the significant improvement in terms of its coverage and compensation depth,China's basic medical insurance system has inherent setbacks in its structure as held by the authors.They hold that the medical insurance as the most important source of compensation for medical institutions,should further reform its structure of financing and reasonably raise the percentage of compensation; adjust the time reference and space reference for prepayment estimation such as the total prepaid amount; deepen supportive reforms for the payment manner.All these measures aim at minimizing impact of the payment control mechanism on routine medical activities and exploring diversified payment manners that are feasible.
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The paper introduced the exploration made by Shanghai SongJiang District in its compensation mechanism for public hospitals and community health centers.This attempt aimed at increasing government financial support,identifying public health needs in the development of public medical institutions,developing the compensatory measures to fit the task completed,and the service provided and individual items.It took such factors as the present personnel,workload,population and area taken into account.All these are designed to make the mechanism more appropriate and fair.
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As introduced in the paper,Australian government subsidize the public hospitals with all their budget needs as compensation,with the two levels of governments constituting the largest buyer of health products and services in the country.In addition,the government supports the hospitals with their facilities.A rational government investment mechanism is proposed with reference to such a model for the ongoing reform of public hospitals in China.
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Access of safe, effective, convenient and affordable medical and health care services to the people is set as the goal of public hospitals health services as stated in the "Guidelines for Public Hospitals Pilot Reform". Such a goal, however, can hardly be achieved by mechanism changes within the public hospitals. The input and output of public hospitals rely critically on such factors as the input mechanism, regional pattern of healthcare system, the economic and industrial conditions of the region,payment quota and payment approval procedures of medical insurance. This paper set off from the input compensation mechanism of public hospitals in China and analyzed the input and output characteristics of the hospitals. Furthermore, the paper proposed to establish an input compensation mechanism based on public welfare performance for such hospitals. This provided further reference for improving the management of public hospitals and building a public welfare-oriented operation mechanism of public hospitals.
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Reform of the medical service payment system plays a key role in deepening the ongoing health reform.China will launch in a large scale the trials of the payment system for its betterment.The author probed deeply into the current compensation mechanism of public hospitals,as well as the inherent and theoretical roots of the negative outcomes resulting from the item-based payment system.On such basis,the paper discussed the nature of the public hospitals,and the theoretical basis for public hospitals' compensation system.In addition,the author discussed the reform principles and key points for reforming the payment system amid the ongoing health reform,proposing to link this reform with resolving major setbacks of the compensation mechanism of public hospitals.Objectives for the medical service payment system reform are advocated as follows: Cost control,management enhancement,mechanism shift,and win-win,which aim to deep reforms of the public hospitals.