Performance appraisal of the business operation of a public hospital based on entropy weighted TOPSIS method / 中华医院管理杂志

Objective:To evaluate the business performance of an urban public tertiary hospital in Jiangsu province since the comprehensive reform of urban public hospitals started from the end of 2015, for reference in developing relevant policies.Methods:Such level-1 indicators as risk management ability, asset operation ability, revenue and expenditure structure management, asset profitability and future development ability were selected based on literature review, along with 14 level-2 indicators, to build an operation performance appraisal indicator system for urban public hospitals. The entropy weight TOPSIS method was used to evaluate the business performance of an urban public hospital in Jiangsu province from 2015 to 2019.Results:The drugs proportion(a level-2 indicator) under the revenue and expenditure structure management, the growth rate of fixed assets(a level-2 indicator) under the future development ability, and the total return(a level-2 indicator) under the asset profitability, were important ones affecting the business performance of hospitals, with the weights of 0.099, 0.097 and 0.080 respectively. The business operation performance ranking as calculated by the relative closeness, was 2015(0.515), 2016(0.480), 2019(0.467), 2018(0.450) and 2017(0.356) respectively.Conclusions:The reform once resulted in fluctuations in the operation performance of this hospital, with constant declines from 2015 to 2017. With the deepening reform, its performance recovered after 2018 to some extent. It is suggested to improve the business operation performance of urban public hospitals by optimizing their income and expenditure structure, improving their asset operation ability, and matching rationally their asset liability structure, among other measures.

Effect of the general reform on county-level hospitals′ financial performance: a case study / 中华医院管理杂志

Objective:To analyze the impact of the comprehensive reform of public hospitals on the economic operation of county-level hospitals, by taking a county-level hospital as an example.Methods:The hospital launched the public hospital general reform in 2014. The hospital information system, hospital resource planning system and cost accounting information system collected the data of hospital business operation, expenditure/revenue, reimbursement for revenue loss due to " drug zero price gap" policy, charges and costs from 2014 to 2019, which were used to calculate the cost of medical service items and disease costs. The hospital′s service volume, changes in medical expenses, income structure, balance of revenue and expenditure and the compensation level for the zero difference rate of drugs were analyzed by descriptive analysis, and the actual charge and cost difference of medical service items and diseases were analyzed by comparative analysis.Results:Compared with 2014, the number of outpatient/emergency, surgery and discharge in 2019 increased by 31.51%, 40.21% and 12.21% respectively, and the average hospitalization cost increased by 4.39%. The proportion of drug cost and material cost decreased by 4.27 and 1.78 percentage points respectively, the proportion of laboratory tests and examinations cost increased by 3.15 and 3.98 percentage points respectively. Changes in the proportion of expenses reflecting the value of technical labor services, such as surgery, treatment, diagnosis and nursing, were all less than 0.60 percentage points. Since 2017, the business expenditure of the hospital had exceeded the income. The proportion of drug income reduced due to " drug zero price gap" policy compensated by medical service income had decreased from 82.00% in 2015 to 58.63% in 2019, and 66.82% of medical service items were defective items. In addition to type 2 diabetes, the actual charges of the 9 main " list" diseases were lower than the standard cost accounting values.Conclusions:After the comprehensive reform of medical price, there may be a large revenue/expenditure gap in a short term, and the cost may be higher than the charges. When formulating the comprehensive reform policy of regional pharmaceutical prices, we should consider the superposition effect of the policies implemented in the same period, and strengthen the short-term financial responsiveness, to provide space for public hospitals to gradually adapt to the reform.

Economic evaluation of treatments under dental general anesthesia and protective stabilization / 中华口腔医学杂志

Objective@#To conduct economic evaluation of treatments under dental general anesthesia (DGA) and protective stabilization (PS), in order to compare the cost and the final therapeutic effect of these two treatments.@*Methods@#Retrospectively studied twenty-six 2 to 4 years old patients treated under DGA and twenty-seven treated under PS in the Department of Pediatric Dentistry, Peking University School and Hospital of Stomatology. The general information, treatment information and total treatment cost information of patients were collected. The cost and cost-survival time ratio of the two groups were compared in units of people and tooth respectively. When compared in unit of people, patients were divided into two groups depending on the number of teeth treated, when compared in unit of tooth, teeth were divided into two groups depending on the treatment received, i.e. restoration or root canal treatment. In addition, we recalculated and compared two groups under the assumption that the treatment charges of DGA was consistent with common outpatient charges.@*Results@#The tooth average cost and cost-survival time ratio of each patient in DGA group which were [(1 133.87±87.37) yuan] and [3.51 (1.30, 5.72) yuan/d] respectively were significantly higher than those in PS group which were [(303.81±155.34) yuan] and [1.54 (0.95, 2.13) yuan/d] respectively (P<0.01). The number of teeth and the way of treatments wouldn't change the result. The recalculated result of the cost-survival time ratio of each patient in DGA group [1.63 (0.72, 2.55) yuan/d] and PS group [1.54 (0.95, 2.13) yuan/d] showed no significant difference (P=0.455).@*Conclusions@#Patients treated in Peking University School and Hospital of Stomatology showed a significant higher cost and cost-survival time radio in DGA group than that in PS group. If the treatment charges of DGA group was consistent with common outpatient charges, PS group will no longer have economic advantage.

Revisión de estrategias de turismo de salud e identificación de aportes para Santander, Colombia / Review of Health Tourism Strategies and Identification of Contributions to Santander, Colombia / Revisão das estratégias de turismo de saúde e identificação de contribuições para Santander, Colômbia

Introducción: Colombia se presenta como uno de los países con mayor potencial para exportar servicios en los próximos años, en cuanto a turismo de salud se refiere. La imagen de sus médicos en diferentes especialidades ha venido aumentando, gracias a su preparación, calidad y relativo bajo costo con respecto a los países de la región. Santander, concretamente con las zonas francas en salud, ha venido alcanzando reconocimiento a nivel latinoamericano. El potencial que tiene este turismo se argumenta en los logros del sector salud y los efectos en cuanto al turismo internacional y en el desarrollo socio-económico de algunas regiones. Objetivo: Identificar las estrategias exitosas, fortalezas y debilidades del turismo médico en el ámbito nacional e internacional que permitan recomendar acciones estratégicas para generar ventajas competitivas al sector de salud en Santander y lo lleven al liderazgo. Metodología: Revisión de tema, con búsqueda sistemática de información bibliográfica, se utilizaron los descriptores DeCS: "Comercialización de Servicios de Salud", "Turismo Médico", "Economía de la Salud", "Servicios de Salud", "Comercio", "Economía Hospitalaria", en las bases de datos Scielo, Google Scholar, PubMed, además de realizar entrevistas con expertos de las entidades. Resultados: Se encontró que Colombia cuenta con una buena posición a nivel mundial y latinoamericano en términos de turismo en salud destacándose por la oferta de servicios en cardiología, cirugía estética y ortopedia; España cuenta con uno de los mejores sistemas de salud y tiene el séptimo puesto en la comercialización de servicios hospitalarios; India, Israel y Singapur lideran los temas de investigación e innovación posicionándolos también como potencias en el turismo médico. Conclusiones: Comparando a Bucaramanga y Área Metropolitana con otras ciudades y países, aún se requiere mayor reconocimiento como región y aunque se cuenta con entidades certificadas internacionalmente, es necesario trabajar en equipo con otras entidades prestadoras, el gobierno, agremiaciones y formar recursos humanos para atender el mercado internacional. [Vargas-Mantilla MM. Revisión de estrategias de turismo de salud e identificación de aportes para Santander, Colombia. MedUNAB 2017-2018; 20(3): 349-361].

Introduction: Colombia is one of the countries with the greatest potential to export services in the next years, in terms of health tourism. The image of its doctors in different specialties has been increasing, thanks to their preparation, quality and relative low cost with respect to the countries of the region. Santander, specifically with the free trade zones in health, has been achieving recognition in Latin America. The potential of this tourism is argued in the achievements of the health area and the effects in terms of international tourism and the socio-economic development of some regions. Objective: To identify the successful strategies, strengths and weaknesses of medical tourism in the national and international scope that allow recommending strategic actions to create competitive advantages to the health sector in Santander and guide it to leadership. Methodology:Atopic review with a systematic search of bibliographic information, in which DeCS descriptors were used such as Marketing of Health Services, medical tourism, Health economics, Health services, trading and Hospital economy in the databases Scielo, Google Scholar and Pubmed; in addition, interviews were conducted with experts from the entities. Results: It was found that Colombia has a good position in the world and Latin America in terms of health tourism, standing out for the offer of services in cardiology, aesthetic surgery and orthopedics; Spain has one of the best health systems and has the seventh position in the marketing of hospital services. India, Israel and Singapore lead the research and innovation issues, positioning them also as powers in medical tourism. Conclusions: Comparing Bucaramanga and Metropolitan Area with other cities and countries, it needs even more recognition as a region and although there are internationally certified entities, it is necessary to work as a team with other health providers, the government, associations and train staff to serve the international market. [Vargas-Mantilla MM. Review of Health Tourism Strategies and Identification of Contributions to Santander, Colombia. MedUNAB 2017- 2018; 20(3): 349-361].

Introdução: A Colômbia é um dos países com maior potencial para exportar serviços nos próximos anos, em termos de turismo de saúde. A imagem de seus médicos em diferentes especialidades tem aumentado, graças à sua preparação, qualidade e baixo custo relativo em relação aos países da região. O estado de Santander, especificamente com as zonas francas em saúde, vem conquistando reconhecimento na América Latina. O potencial deste turismo é reconhecido nas conquistas do setor de saúde e os efeitos são discutidos em turismo internacional e desenvolvimento socioeconômico de algumas regiões. Objetivo: Identificar as estratégias, pontos fortes e fracos de sucesso do turismo médico no âmbito nacional e internacional que permitem recomendar ações estratégicas para gerar vantagens competitivas para o setor de saúde em Santander e levá-lo à liderança. Metodologia: Revisão do tema, com busca sistemática de informações bibliográficas, foram utilizados os descritores DeCS: "Marketing de Serviços de Saúde", "Turismo Médico", "Economia da Saúde", "Serviços de Saúde", "Comércio", "Economia hospitalar ", nos bancos de dados Scielo, Google Scholar, PubMed, além de realizar entrevistas com especialistas das entidades. Resultados: A Colômbia encontrou uma boa posição no mundo e na América Latina em termos de turismo em saúde, destacando-se pela oferta de serviços em cardiologia, cirurgia estética e ortopedia; A Espanha tem um dos melhores sistemas de saúde e tem o sétimo lugar na comercialização de serviços hospitalares; Índia, Israel e Cingapura lideram as questões de pesquisa e inovação, posicionando-as também como fortalezas no turismo médico. Conclusões: Comparando Bucaramanga e a Área Metropolitana com outras cidades e países, ainda é necessário mais reconhecimento como região e, embora existam entidades certificadas internacionalmente, é necessário trabalhar em equipe com outras entidades de crédito, o governo, associações e capacitar recursos humanos para participar mercado internacional. [Vargas-Mantilla MM. Revisão das estratégias de turismo de saúde e identificação de contribuições para Santander, Colômbia. MedUNAB 2017-2018; 20(3): 349-361].

Comparison of thromboprophylaxis patterns in arthroplasty in public and private hospitals / Comparação entre padrões de tromboprofilaxia na artroplastia em hospitais público e privado

Objective To compare therapy for prophylaxis of venous thromboembolism and costs related to hospitalization of patients undergoing total knee and hip replacement within the context of the Brazilian health system.Methods A retrospective study of patients undergoing arthroplasty in 2010 in a public hospital and two private hospitals in the state of São Paulo, conducted by means of medical record review. Costs were estimated based on the use of health care resources during hospitalization. A descriptive analysis was performed using frequency and mean (standard deviation) according to the type of care delivered (by public or private organization).Results A total of 215 patients were evaluated, and 56.3% were submitted to knee surgery and 43.7%, to hip replacement. Approximately 88% and 98% of patients from public and private health services, respectively, received some form of venous thromboembolism prophylaxis, and enoxaparin was the drug most widely used in both systems. The total cost of prophylaxis was R$ 1,873.01 (R$ 26.38 per patient) in the public service and R$ 21,559.73 (R$ 163.33 per patient) in the private service. For the individuals who presented with thromboembolism, the average cost of hospitalization was R$ 6,210.80 and R$ 43,792.59 per patient in public and private health services, respectively.Conclusion Thromboembolism prophylaxis in patients undergoing arthroplasty is most commonly used in the private health services than public organizations, despite its high costs in both services. The cost per patient with thrombosis during hospitalization was higher than the total cost of prophylaxis, suggesting that prevention is associated to better cost-benefit ratio.

Objetivo Comparar a terapia para profilaxia de tromboembolismo venoso e os custos de pacientes submetidos à artroplastia total de joelho e de quadril dentro do sistema de saúde brasileiro.Métodos Estudo retrospectivo com pacientes submetidos à artroplastia no ano de 2010, em um hospital público e dois hospitais privados no Estado de São Paulo, por meio da revisão de prontuários. Os custos foram estimados com base na utilização de recursos em saúde durante a hospitalização. Análise descritiva de frequência e média (desvio padrão), de acordo com o tipo de atendimento em saúde (público ou privado).Resultados Um total de 215 pacientes foram avaliados, sendo 56,3% submetidos à cirurgia de joelho e 43,7% à cirurgia de quadril. Cerca de 88% e 98% dos pacientes provenientes do serviço público e privado de saúde, respectivamente, receberam algum tipo de profilaxia para tromboembolismo, sendo a enoxaparina o medicamento mais utilizado em ambos sistemas. O custo total da profilaxia foi de R$ 1.873,01 (R$ 26,38 por paciente) no serviço público e R$ 21.559,73 (R$ 163,33 por paciente) no serviço privado. Para os indivíduos com tromboembolismo, o custo médio da internação foi de R$ 6.210,80 e R$ 43.792,59 por paciente atendido nos serviços de saúde público e privado, respectivamente.Conclusão A profilaxia em pacientes submetidos à artroplastia é mais utilizada em pacientes do serviço de saúde privado do que público, apesar dos altos custos em ambos os serviços. Os pacientes com tromboembolismo tiveram um custo maior do que aqueles apenas com profilaxia, mostrando que a prevenção está associada a um maior custo-benefício.

Strategic alliances: an analysis of Catalan hospitals / Alianzas estratégicas: un análisis de los hospitales catalanes

OBJECTIVE: To analyze the strategic alliances that Catalan hospitals form with other health care entities and other types of institutions to foster technological and organizational innovation. METHODS: Qualitative case studies were conducted at a sample of 16 public hospitals in Catalonia, Spain. The sample was limited to three (Level 1-3) of Catalonia's four levels of hospitals (classified according to the complexity of the diagnoses and treatments they provide), but Level 4 hospitals were considered as part of the network in the analysis of the alliances. At each hospital, interviews were conducted with the manager, the medical director, and the service director, using a questionnaire that gathered information on strategic alliances with a focus on telemedicine. Qualitative data processing was applied to identify patterns of alliances between hospitals and other institutions. RESULTS: Catalan hospitals interact with other health care agents through three main types of associations: alliances with other hospitals (the most frequent type); alliances with primary care centers (reported mostly by Level 2 hospitals); and alliances with other institutions (e.g., local government, medical companies, and universities). Human resource-sharing (staff mobility) and training were reported most frequently as reasons for creating the alliances. CONCLUSIONS: Strategic alliances are formed between hospitals and other health care agents to help improve performance, competitiveness, and services provided to users. These results may help health care system managers promote strategic alliances as a means of optimizing system efficiency without reducing user satisfaction-a key challenge within the context of the current economic situation.

OBJETIVO: Analizar las alianzas estratégicas que los hospitales catalanes forjan con otras entidades de atención de la salud y otros tipos de instituciones para fomentar la innovación tecnológica y de las organizaciones. MÉTODOS: Se condujeron estudios cualitativos de casos en una muestra de 16 hospitales públicos de Cataluña, España. La muestra se limitó a tres (Niveles 1 a 3) de los cuatro niveles de los hospitales catalanes (clasificados según la complejidad de los diagnósticos y los tratamientos que proporcionan), pero los hospitales de Nivel 4 se consideraron parte de la red en el análisis de las alianzas. En cada hospital se efectuaron entrevistas con el gerente, el director médico y el director de servicio, mediante un cuestionario que recopilaba información sobre las alianzas estratégicas con hincapié en la telemedicina. Se aplicó el procesamiento cualitativo de datos para identificar los modelos de alianzas entre los hospitales y otras instituciones. RESULTADOS: Los hospitales catalanes interactúan con otros agentes de atención de la salud a través de tres tipos principales de asociaciones: alianzas con otros hospitales (el tipo más frecuente); alianzas con centros de atención primaria (según lo informado principalmente por los hospitales de Nivel 2); y alianzas con otras instituciones (por ejemplo, el gobierno local, las empresas médicas y las universidades). El intercambio de recursos humanos (movilidad del personal) y la capacitación fueron mencionados como los motivos más frecuentes para crear las alianzas. CONCLUSIONES: Se forman alianzas estratégicas entre los hospitales y otros agentes de atención de la salud con el objeto de mejorar el desempeño, la competitividad y los servicios prestados a los usuarios. Estos resultados pueden ayudar a los gerentes de los sistemas de atención de la salud a promover alianzas estratégicas como medio para optimizar la eficiencia del sistema sin reducir la satisfacción de los usuarios -un reto clave en el contexto de la situación económica actual.

Analysis of anti-infection drug usage in 11 hospitals of Shanghai during 2003-2005 / 第二军医大学学报

Objective: To evaluate the current situation and trend of anti-infection drug usage in 11 hospitals of Shanghai during 2003-2005. Methods: Using the cost ranking approach, we analyzed the anti-infection drug usage in 11 major hospitals of Shanghai during 2003-2005. The drug species, consumption, cost, manufacturer, etc. were analyzed by Excel 2000 software. Results: It was found that the cost of anti-infection drugs in the 11 hospitals occupied 22. 65% of the total drug expenditure during 2003-2005 and the expenditure decreased at an annual rate of 4.02%. We also found that 80% of the anti-infection drugs were antibiotics. The consumption of β-lactamase inhibitor valued 44.120 5, 73.696 7 and 95.163 0 million Yuan in 2003, 2004 and 2005, respectively (with a yearly growth of 46.86%), ranking the 3rd in 2003 and the 2nd in both 2004 and 2005. The consumption of cephalosporins ranked the first during 2003-2005, The top 20 anti-infection drugs occupied nearly 80% of the total consumption; the consumption of sulbactam sodium/cefoperazone raised from the 17th in 2003 to the 5th in 2004 and to the first in 2005. Conclusion: The consumption of anti-infection drugs has been restrained; cephalosporins are still the major drugs in clinical practice; and the consumption of sulbactam sodium/cefoperazone is on the rise year by year.

Analysis of anti-infection drug usage in 11 hospitals of Shanghai during 2003-2005 / 第二军医大学学报

Objective:To evaluate the current situation and trend of anti-infection drug usage in 11 hospitals of Shanghai during 2003-2005.Methods:Using the cost ranking approach,we analyzed the anti-infection drug usage in 11 major hospitals of Shanghai during 2003-2005.The drug species,consumption,cost,manufacturer,etc,were analyzed by Excel 2000 software. Results:It was found that the cost of anti-infection drugs in the 11 hospitals occupied 22.65% of the total drug expenditure during 2003-2005 and the expenditure decreased at an annual rate of 4.02%.We also found that 80% of the anti-infection drugs were antibiotics.The consumption of?-lactamase inhibitor valued 44.120 5,73.696 7 and 95.163 0 million Yuan in 2003,2004 and 2005,respectively(with a yearly growth of 46.86%),ranking the 3rd in 2003 and the 2nd in both 2004 and 2005.The consumption of cephalosporins ranked the first during 2003-2005.The top 20 anti-infection drugs occupied nearly 80% of the total consumption;the consumption of sulbactam sodium/cefoperazone raised from the 17th in 2003 to the 5th in 2004 and to the first in 2005.Conclusion:The consumption of anti-infection drugs has been restrained;cephalosporins are still the major drugs in clinical practice;and the consumption of sulbactam sodium/cefoperazone is on the rise year by year.