ABSTRACT
Objective:To explore the price formation method and price standard in the big data diagnosis-intervention packet.Methods:The expenditure data and income data of 95 medical institutions in Shanghai in 2018 were used for analysis, including 33 municipal hospitals and 62 district hospitals. After using the standardized data of disease score, the medical institutions in the region were divided into four quadrants with the regional average of unit price per index and cost per index as the coordinate axis. The best quadrant of income and cost was found out, namely the high quality range. The geometric center was calculated in the high quality range, and the unit price per index of the geometric center was taken as the cost standard.Results:For the district hospitals, there were 20 hospitals in the first quadrant, 8 in the second quadrant, 24 in the third quadrant and 10 in the fourth quadrant; For the municipal hospitals, there were 7 hospitals in the first quadrant, 5 in the second quadrant, 12 in the third quadrant and 9 in the fourth quadrant. In the third quadrant, the average income and cost of medical institutions were lower than the average of the city, and the income could cover the cost. The third quadrant was the high quality range. The unit price per index of the third quadrant geometric center of district hospitals was 14 115.4 yuan, and that in municipal hospitals was 15 559.1 yuan, which could be used as the corresponding cost standard.Conclusions:The price discovery mechanism based on objective data and high-quality interval geometric center method can remove the impact of unreasonable charges or unreasonable behavior on medical income, and reflect the guidance of the standard price of medical insurance payment.
ABSTRACT
OBJECTIVE： To systematically evaluate current status of charges in pharmacy intravenous admixture services （PIVAS）， and to provide reference for the formulation of China’s pharmacy intravenous admixture services （PIVAS） charging standards. METHODS： Retrieved from PubMed， Embase， Cochrane library， CBM， CNKI， VIP， Wanfang database and related goverment websets， the literatures about current status evaluation of charges in PIVAS of China were collected during the establishment of database to Jan. 2019. Cost estimation， charge standard， influential factors and other indicators were collected， and the results were presented by descriptive analysis. RESULTS： A total of 5 literatures were included， all of which were reviewed. According to the existing literatures， except for Shandong， Guangdong and Yunnan provinces， there were no regional charge standards in other provinces （districts and cities）. The cost estimation methods of PIVAS in these three provinces were basically the same. The cost could be obtained by adding up the business fees， labor fees， fees of medical instruments purchase and use， indirect fees etc. Dispensing charges in PIVAS were 3-5 yuan per piece for general drug， 5 yuan per piece for antibiotics and 8-12 yuan per piece for cancer chemotherapeutics， 20-35 yuan per piece for TPN. The charging level was mainly affected by local prices， PIVAS scale， hardware investment， management and other factors. CONCLUSIONS： There is no unified charging standard for PIVAS in most provinces （districts， cities） of China. The cost estimation methods of the hospitals from the included literatures are basically the same. It is necessary to construct national PIVAS charging standard and cost estimation method， which could provide a basis for formulating the price of medical and health services.
ABSTRACT
OBJECTIVE:To provide reference for improving the charge system of drug registration in China so as to promote work efficiency and quality of drug registration. METHODS:Through comparing the implementation of drug registration and evaluation in Japan and China(registration institution,process,cycle,etc.),Japanese charge standard of drug registration system was evaluated and its characteristics were analyzed,so as to put forward the suggestion for charge standard reform of drug registration in China. RESULTS & CONCLUSIONS:Japanese drug registration was internal review, with the independent administrative institution Pharmaceuticals and Medical Devices Agency(PMDA)as main body,combined with the opinions of the external experts;there was a strict control standard for the registration cycle. Specific fee was confirmed by the charge standard according to new drug registration,drug re-registration,first application,extension application,first or second category of drugs, orphan drugs or non-orphan drugs. Japanese charge standard was characterized with clear classification of charge standard,high fees, close relationship of charge level with drug types. The procedures for drug registration were more cumbersome in China,and involved more relevant institutions and personnel at different levels;there was not strict restriction on registration period;relatively rough charge standard,low fee and not detailed charge classification also existed. It is suggested to draw lessons from the experience for charge standard formulation and management of drug registration in Japan,improve the current drug registration charge system in China by adding charge standard of drug registration into annual report of Center for Drug Evaluation,raising the amount of fee, subdividing the charge items and setting up the feedback mechanism,which lay a solid foundation for improving the efficiency and quality of drug registration in China.