ABSTRACT
Objective To analyze the impact of the comprehensive reform of public hospitals in Tianjin on the cost structure of inpatients at a tertiary general hospital.Methods Homepage data of the medical records from January 2015 to June 2018 were selected from a tertiary general hospital in Tianjin.The Beijing version of diagnosis related groupings(BJ-DRGs) was used to compare the expense structure of these inpatients before and after such a reform.Wilcoxon signed rank sum test,Z test and Pearson correlation analysis were performed for each index.Results Since the reform,the number of hospital discharges and that of DRGs had remained basically stable,while the case mixed index(CMI) weight increased slightly(from 1.0065 to 1.0386);the total hospitalization expenses,medical expenses,nursing expenses,management expenses and consumables expenses had increased.On the other hand,the expenses of medication and medical technology decreased,and the differences of these expenses were statistically significant (P ＜0.05).The time consumption index (0.87) and drug consumption index (0.80) were always lower than average,but the cost consumption index (1.38) remains above average with a slight rise.Conclusions The reform of public hospitals in Tianjin has encouraged such hospitals to improve their service procedures by adjusting such measures as pricing of medical services,and promoted their proactive management of hospitals.Hence the initial goal of "controlling costs,adjusting structure,and reducing costs" has been met.However,cost rise control still deserves major attention.
ABSTRACT
Reform of public hospitals is key to the healthcare system reform.This article introduced how Hangzhou implemented such a reform of " Hangzhou characteristics" by referring to the hospital reform framework of the World Bank, and the theoretical achievements and practical experiences of domestic public hospitals′reform.Led by the service concept of " Medicine has its limitations but we have the courage to overcome, service is boundaryless and we must pursue excellence" , Hangzhou has established a public hospital value system of " reorientation to public welfare".The smart healthcare system serves as a focus, to support the delicacy management of the hospitals. The construction of hierarchical medical care system functions as the pillar, to support the coordinated development of hospitals, primary health institutions and public health institutions.This way a public hospital comprehensive reform mode is established featuring " one value system, 2 levels of organization structure, 6 mechanisms, and 19 supporting measures ". Its experiences may serve as reference to streamline hospital internal operation and external cooperation mechanism.
ABSTRACT
Objective To evaluate the effect of the comprehensive reform of medical prices of traditional Chinese medicine hospitals in Jiangsu Province,to provide empirical support for the effectiveness of the reform of government drug prices,and to provide suggestions for further deepening the reform.Methods Based on the effect model of Wei Tang's public policy evaluation model,according to the comprehensive reform goal of medical price,analyzing the effect before and after the implementation of the policy.Results After the reform,the financial subsidy income,medical insurance income and service income have increased,the proportion of drug revenue has dropped by 3.3％,and some medical control fee indicators have reached the policy standards,but the asset liability ratio has increased.Conclusion The reform has achieved some initial results.The income compensation is basically reasonable,but still not enough.The income structure is obviously optimized.The control of medical expenses has improved,but it has not reached the ideal state.
ABSTRACT
With the implementation of the comprehensive reform of medical separation in Beijing at April 8 of 2017, more than 3600 medical institutions in the city were involved, including the public hospital of traditional Chinese medicine. ThisIt was an opportunity of public hospitals of traditional Chinese medicine, and it also showed several challenges. This paper analyzed the situation separation of medicine and drug, the opportunity and challenge to put forward reasonable countermeasure and suggestion for the public hospital of traditional Chinese medicine.
ABSTRACT
Objective:To analyze the revenue and expenditure structure of county public hospitals in Shanxi since new medical reform in order to provide evidence about county public hospital reform.Methods:Related data of revenue and expenditure in county public hospitals of Shanxi from 2010 to 2016 were used and analyzed by descriptive analysis and the indicators of the structural changes.Results:The effect of compensation mechanism reform appeared;drug income ratio descended.Drug income was still the important factor to keep hospitals running normally;fiscal subsidy increased by years,public welfare of county public hospitals was prominent;technical services revenue which realized the value of technical work performed by medical personnel changed little.Conclusion:The cost structure of public county hospitals needed further adjustment.It should establish the comprehensive evaluation system of unreasonable growth of medical expenses,actively implement modern hospital management system,carry out synthetic?configuration of medical resources in county area,establish a dynamic medical service pricing mechanism combining market regulation with government guidance under the government's macro-controlling,and introduce the disease related group to hospital performance evaluation.
ABSTRACT
With the opportunity of the comprehensive reform of professional postgraduate education,Peking University design the professional postgraduate education structure to social need,explore the training mode of DrPH,PharmD,MMT with international standards;To implement the spirit of medical cooperation,promote the organic linking of training of MD and specialist.
ABSTRACT
Taking 175 township public hospitals in Jiangxi as the samples,descriptive statistics and comparative analysis were applied based on their financial yearly report data from 2012 to 2016 to analyze the operation situation of hospitals before and after the public reform,analyze the influences of medical reform policies on township public hospitals and propose relevant policies,so as to promote the soon coming urban public hospital reform in Jiangxi.
ABSTRACT
This study aimed at exploring the economic operation and developing trend of county-level public TCM hospitals in Guangxi Province,promoting the comprehensive reform of county-level public hospitals with feasible countermeasures and suggestions.In this study,forty-seven county-level public TCM hospitals were involved in the analysis of their economic operations and benefits by constituent ratio analysis,ratio analysis and trend analysis.As a result,the average gross income of the hospitals exceeded the total expenditure with a slight surplus.Drug income contributed the biggest share of the medical income,while the ratio of Chinese drug income to the medical income was increasing year by year.The debt ratio increased from 38.7％ in 2009 up to 44.6％ in 2013,being over 30％ in this period.In conclusion,it was demonstrated that problems were found in the lack of financial assistance,the low efficiency of economic management and the increasing average medical charges,which should be addressed by increasing investments to TCM hospitals,strengthening the performance appraisal and adjusting the charges of TCM medical services.
ABSTRACT
Objective To understand the present situation of city-level public hospital reform and to analyze the impacts on different clinical departments by analyzing the changes of hospitalization expenses of a third-level grade-A hospital from Anhui Province.Methods The inpatient data from April to September,2014 and 2015 of the third-level grade-A hospital were collected.Three typical diseases in Department of Internal Medicine,Surgery,Gynecology and Pediatrics respectively,were chosen to compare the changes of expenses and the structure before and after the reform.Results Overall,hospitalization expenses saw a declining trend after city-level public hospital reform.But,it was different in each department.The structure of hospitalization expenses became more reasonable after reform,however,the medical material expense remained a question.Conclusion The city-level public hospital reform reduces drug costs and inspection fees for inpatients effectively,thereby abating the overall cost of hospitalization,and the structure of hospitalization expenses becomes more reasonable.But the changes of hospitalization expenses in different departments reflect some problems.
ABSTRACT
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.
ABSTRACT
Objective:To analyze the implementation and effectiveness of primary health care reform in Feixi county, Anhui province. Methods: This paper uses data analysis of interviews with key insiders, policy documents and archives, as well as institutional questionnaire survey and other methods to collect information, and then it com-bines qualitative and quantitative research to arrive at research findings through cross-analysis and interpretation. Re-sults:From 2010 to 2014, the reform enhanced the capacity of primary health care in four main aspects, including capacity building of primary health care personnel, network construction of primary health care system, improvement of working conditions, and system construction of institutional management. Accordingly, the human capacity of pri-mary health care personnel was improved, their enthusiasm for work increased, their income was raised, the working conditions were improved, the cooperation mechanism for vertical and horizontal health care services was established, and the consultation rate and primary health care utilization in Feixi county increased. Conclusion:Both the“bottom-up” exploration approach and “from point to area” implementation strategy adopted by Feixi county have not only been the core content of primary health care system’s comprehensive reform, but also effectively leveraged the other aspects of the reform. They have played an important role in deepening medical reform and establishing institutional mechanism of health care system.
ABSTRACT
From the related work of comprehensive reform pilot for full-time Master of Public Health (MPH) professional degree education, we introduced Peking University and Fudan University's specific measures and achievements of cultivation of MPH position, admissions, curriculum, faculty, teaching, research, dissertations and etc. While comparing China's modes with John Hopkins University's and Harvard University's, we gave advice and made suggestions for our future full-time master of public health graduate training in China.
ABSTRACT
Based on the organization and implementation of the comprehensive reform of countylevel public hospitals in 15 provinces (municipalities)in southern China,the research discussed the progress and problems of such reforr.The progress made and areas of the reform vary among provinces and municipalities.For example,the reform has completely covered all the counties in four provinces such as Zhejiang and Jiangsu province.Medicine markups have been canceled in all the pilot counties by adjusting the service prices to pave the way for hospital compensation.Contemporary hospital management,remuneration system and personnel system reform are also main targets of the reform,while the collaboration between superiors and subordinates,and hospital regulatory system have recently been included.Problems are also found with the current reform:for example,lack of attention for the system reform,no fundamental changes in place in the business orientation of hospitals,as well as problems in collaboration among departments,and hospital debts.
ABSTRACT
Objective: As the breakthrough for public hospital reform in China, County public hospital comprehensive reform has become the main part of the reform, the reasonable use of New Rural Cooperative Medical System(NCMS) would strongly push the process of new medical reform. Methods: The method of mathematical modeling was applied in policy imitate of hospital operation historical data, to estimate the increasing of decreasing status of NCMS hospital compensation expenditure after the implementation of county-level public hospital comprehensive reform measurement in 10 county-level public hospital. Results: Through analyzing the operation data of applying county-level public hospital comprehensive reform measurement in 10 county-level public hospital from 2010 to 2012, there was 66.67% annual time, the NCMS compensation expenditure for public hospitals increased to 23.075 6 million yuan, which increased by 1.691 7 yuan averagely. Conclusion: After the implementation of comprehensive reform policies, the influencing factors of NCMS funds on the decreasing degree of county-level public hospital expenditure were mainly the proportion of pre drug addition ratio and basic drug sales in the total drug sales.
ABSTRACT
Medical service electronic card should be given to each citizen• This card should be owned by each citizen from the nearlis years and it should be the payment tool in all secondary and tertiary hospitals• The pledged cash distribution by the politicians during the election campaigns should be placed first, in card• The card balance should be no less than MNT200,000. when patients needs to certain medical service on secondary and tertiary Hospitals• This payment tool should be able to be converted to cash for diagnosis, treatment, medical consultation and health supporting activities.• It should be transferable to family members and friends.• Some percentage of unused balance at the end of each year could be given to the individual as a bonus for protecting his health and the remaining balance could be kept intact for next year’s medical services• The card can be transferable upon death of the owner• Make a policy when the amount needed for the medical services exceeds the card balance for a given year (certain percentage of expenses of medical procedures that are done few times, but expensive could be covered by health insurance fund or by the state. This will enable the outflow of money to be directed to Mongolia and it will serve as investment in hospitals in Mongolia)Benefits of using the electronic payment card:• Patients can freely choose one’s doctor and hospital and he is able to receive one’s desired medical services• One is able to control the medical services and is able to participate equally in the processThe state will be able to:• Provide consistent and outreaching medical services• Initially the state will take the responsibility for first aid, social health services and emergency aidThe electronic card should cover:• Secondary hospital services (fully)• Tertiary hospital services (majority)Other advantages of the electronic card:• As all hospitals are on the same starting point, the medical staff will be highly motivated for a constructive competition• Improvement in qualification, accountability and service quality of the staff• Completely stop the appointment of hospital management by political party affiliations or connections. The top management will strive to make a team of qualified and skilled staff• The staff will be able to receive compensation packages that are correlated to their knowledge, qualifications, experience, skills and performances• When hospitals have “state enterprise” status and it has independent operation and management, there will be no improper activities such as outside pressures on supply and renovation of equipment and services, bidding intrigues and forced consumption and the hospitals will be able to work in business like mechanismThe biggest advantage is that there will be an unprecedented large inflow of money into health care system of MongoliaTherefore, there will be the following benefits:• Hospitals will be able to renovate, introduce know-how, train their staff and will be able to have additional funding for pay increase for the staff• It will be instrumental in launching a high cost, world class treatment and diagnosis department in the near future (heart, brain surgery and organ transplantation etc.)• There will be more highly qualified clinician doctors (educated by both of eastern and western medicines) as the hospitals will function on the basis of demands and preference by patients.• Due to the real market mechanisms only the competent hospitals will continue working after competition• Health supporting organizations will be financially sound• Because patients will have their payment tools in a form of the electronic card, some bureaucratic procedures such as the provincial affiliation and 13th form will be eliminated• Main information about the patients could be entered into the card, for example, Thaiwan has this system, so, it will create a database• When the balance is not used some interest could be accrued on the balance, like in Singapore.• Any level of hospital will be able to transform to a private entity by market principles.• It will eliminate subsidized, inefficient, high cost medical service structure that was built in socialist time and create a demand-based, smaller, but powerful and qualified medical system in Mongolia.• There will be a database with true information• The state will be able to count the population again• The state budget will increase by profit tax collection• The equipment and assets of bankrupt hospitals (with poor management and not customer oriented) should be sold in bidding and the other hospitals will be able to introduce know-how, will have funding for loans, training and new jobs.