Preliminary exploration of medical service price reform based on choice behavior motivation / 中华医院管理杂志

Medical service pricing system is the basic system of health economics, which has a profound impact on physicians′ medical behavior and the running mode of hospital. Rui′an City, Wenzhou City, Zhejiang Province, freed up the cost space of drug and consumables based on the reasonable diagnosis and treatment behavior of doctors and selection of drug and consumables in the hospital procurement link. 68% of the free space was used to improve the price of medical services. 248 medical service items with obvious cost inversion were selected, such as nursing, traditional Chinese medicine, diagnosis, etc., and the price adjustment range was determined according to the agreed free space limit. Meanwhile, the credit mechanism of Alipay was applied to synchronously implement " vacating space and adjusting structure" , so as to solve the game problem between medical treatment and medical insurance, broaden the path of the " translation compensation method" of medical service price reform, and produce policy superposition and linkage effect with the reform of medical insurance payment mode.

Construction and application of a dynamic adjustment model of medical service price in public hospitals / 中华医院管理杂志

Constructing a scientific, standardized and reasonable dynamic adjustment model of medical service price has important reference value for the dynamic adjustment of medical service price in public hospitals. In view of the current situation at home and abroad, the authors analyzed the influencing factors of such adjustment, and constructed a dynamic adjustment model of medical service price, referring on the resource-based relative value scale theory. This model could calculate the intrinsic price of individual medical services, taking into full account the basic human resource consumption and time consumption, as well as the technical difficulty and risk degree of such services. On such basis, the economic development and price level of individual regions were integrated into the model to calculate the extrinsic price of these services. Taking the debridement(suture) service of a hospital as an example, this model was used for empirical research. It was estimated that the extrinsic price of a debridement(suture)(small) service was 54.82 yuan, that of a debridement(suture)(medium) service was 104.34 yuan, and that of a debridement(suture)(large) was 142.93 yuan. The price gap between the actual price and these estimated prices was 10.18 yuan, -26.34 yuan and -51.93 yuan respectively. This research proved that the model could be helpful to sort out the price ratio relationship and better reflect the technical labor value of medical workers.

Analysis on the current situation of medical service price from the perspective of medical insurance integration in the Yangtze River Delta / 中华医院管理杂志

Objective:To sort out the medical service price management in provinces of the Yangtze River Delta, and identify problems in the process of promoting the integration of medical insurance in the said region.Methods:The service price reform policies and current medical service price items specifications as of December 2020 were collected from the official websites of the reform and developmet committees, health comissions and health insurane bureaus of these provinces. Descriptive analysis using R 4.0.2 software were conducted.Results:Given the reform of medical service prices advanced in these provinces successively, the current medical service price items were not yet unified. In terms of the numbers, Jiangsu topped the rest by 4 457 basic items, while Zhejiang ranked the lowest at 3 914. In terms of decomposed items, Zhejiang topped the rest by 1 988, 17.6 times that of Anhui province. In terms of pricing level, the average price of medical services in Shanghai topped the rest by 1 041.6 yuan, while Jiangsu province was the lowest at 768.6 yuan. The price of some items varied by more than 20 times among these provinces.Conclusions:The provinces in the Yangtze River Delta had significant gaps in medical service price items setup and price levels. It is necessary to promote the regional coordinated specifications of medical service price items, further optimize the price levels, improve the methodological system of medical service price comparison, and promote the integration of medical insurance in the Yangtze River Delta.

Status quo and countermeasures of the new medical service price items management in China / 中华医院管理杂志

New medical service price items (hereinafter referred to as the new item) management is key to deepening medical service price reform.Based on the review of the policy development of the new item management and status quo of provincial-level practices, the authors sorted out the problems in the new item management as follows. Namely the new item connotation was not clearly defined, linkage with the national specifications for medical service price items was not yet well defined, the approval process was imperfect, the pricing fundamentals were weak, and the maturity term system was to be strengthened. According to such analyses, the authors proposed countermeasure recommendations for optimizing the new item management: to introduce and implement unified national specifications for medical service price item and the new item guidance as quickly as possible, to promote the linkage between the new item management and the dynamic adjustment mechanism of medical service prices, and to strengthen institutional construction of the new item management.

Discussion on Related Problems of Mechanism of Regional Medical Price Coordination / 中国卫生经济

With the advancement of medical and health system,the reform of medical price became one of cores in new medical reform.According to the principle of "the total quantity control,the structure adjustment",in recent years,every region adjusted the medical price.However,the regional medical price disharmony was influenced by the mechanism of information-sharing,the differentiation right of pricing and management and setting basis and cycle.It followed the regional medical price disharmony concern over the principle,content and method of mechanism of regional medical price coordination for optimizing medical price management,so as to provide references for further optimizing medical service price management.

Research on Medical Service Price Dynamic Adjustment Strategy in the View of Tripartite / 中国卫生经济

There ass an urgent call for the dynamic medical service price-adjustment mechanism with the fully launched Zero Markup policy,however it was lacking of one unified coordination mechanism between departments.It analyzed the responsibilities and challenges of four departments(Health,Pricing,Health Insurance and Finance Department).Also,one theoretical model has been established for analyzing the impacts on the four departments by the scope of pricing-adjustment.By witnessed the evidences on the price-adjustment,it highly recommended that the strategy for price-adjustment should go with high frequency but in a minor change.Meanwhile,it also proposed that to build one well-coordinated mechanism,introduce third parties to involve,and establish one simulation system for price-adjustment to push forward the progress of dynamic price-adjustment mechanism.

The dynamic adjustment mechanism of medical service price in the United States and its implications for China / 中国卫生政策研究

The establishment of a scientific and reasonable medical service price dynamic adjustment mechanism is the focus of the current reform of public hospitals in China.This paper analyzed the medical service price reform history in the United States, the price dynamic adjustment of the main body and its process, as well as the development trend of medical service price reform.At the same time, the existing problems of medical service price adjustment in China were briefly analyzed, and put forward 1) the establishment of multi-participant dynamic adjustment model;2) the establishment of the medical service standard value system, strengthening Medicare payment standard construction;3) and gradually changing the current fee-for-service payment system and establishing DRGs and performance based payment mechanism and other policy recommendations.

Quick termination and implications of medical service price reform policy in Chongqing city:A case study of health policy with perspective of policy actors / 中国卫生政策研究

Local policy innovation is a distinct feature in the arena of public administration in China. Previous researches concerned with local policy innovation experience and policy introduction, but they pay little attention to the failure of policy innovations and their termination. This paper uses the theory and concept of public policy process to analyze the reasons for the quick termination process and its mechanism taking healthcare policy as a case study in Chongqing city. It concludes that relative policy strategy is closed in decision-making. The strategy of some special policy target groups as well as the mutual agitation between public and media agenda are the main reasons for the rap-id end of policy innovation. This study is helpful to understand the factors and logic mechanism of the quick termina-tion of local policy innovation as a special type of public policy change which is termed as short-lived and make more scientific healthcare policy decision making and reform in China.

Impact of separating drug sales from medical services reform on Beijing Cancer Hospital from the perspective of medical insurance data / 中国卫生政策研究

objective:To analyze the policy impact of separating drug sales from medical services on a certain oncology hospitals in Beijing,and provide the basis for further development and adjustment of the reform. Methods:Using interrupted time series segmented regression model to analyse the instant change and trend change of medical service utilization by outpatient(including tumor-specified outpatient) and overall inpatient services,especially in in-dicators of drug proportion,self-pay ratio,and so on after the reform. Results:Tumor treatment is a relative specific-ity. The proportion of previous inpatients in tumor specialized hospitals ranged between 49.31% and 49.96%, and the actual compensation rates were between 57.05% and 63.57%. In our case analysis, the expenditure of outpa-tients dropped after this reform,with RMB 4.33 monthly decline on average cost and with 2.32 percentage monthly decrease on a self-pay rate. Drug proportion was declined expectedly,and the proportion of outpatient and inpatient drugs immediately decreased by 4.63% and 2.98% respectively after the reform. Therewith consumptive material proportion was raised, and the proportion of outpatient and inpatient materials instantly increased by 0.22% and 1.17% respectively. Conclusion:As per the results of this study,the reform has weakened the economic dependence on drug income in sample hospital and reduced the burden on patients. However,tumor treatment is on rigid demand and brings about a relatively great impact on hospital's finance and medical insurance fund. The rationality regards of cost-shifting should be investigated in the long run.

The enlightenment of the pilot results of “Medical and Pharmaceutical Separation” in Beijing city on th e reform of public hospitals:A case study of Beijing Chaoyang Hospital / 中国卫生政策研究

This paper aims at evaluating the effectiveness of the “Medical and Pharmaceutical Separation” re-form in Beijing in three years , and put forward suggestions for the reform of public hospitals .Using data obtained from hospital database, we compared changes in the proportion of drug cost , the average drug expenditures per time, medical workload , quality , income and structure .The key findings of this study show that after the reform , the quali-ty of medical services has improved .Compared to one year before the reform , in the third year of reform the outpa-tient and inpatient medicine accounted for decreased to 16.98%and 13.3%, from 25.57%and 36%, respectively;and the outpatient and inpatient patients per capita medical expenses decreased by 21.39%and 34.8%respectively. The health care revenue increased by 68 .1%compared with before reform .Drug revenue fell 14.29%before the re-form.Medical service fee income reached 243,500,000 yuan.Income from medical examination and laboratory tests in-creased by 52.60%.Based on the findings of the present investigation , the Trial“Medical and Pharmaceutical Separa-tion” to control the cost of drugs achieved good results .Therefore ,it would be advantageous in adopting the reform of public hospitals in the next step toward the medical examination separated , adjust the price of medical services ,etc.

Evaluation on the difference between levels of medical services price and policy implications in Sichuan province / 中国卫生政策研究

This paper designed an index for the differences in medical service prices and this index therein named the Hospital Price Difference Index ( HPDI) which is used as a quantitative tool for evaluation. During evalua-tion, the paper measured the levels of prices and the factors of influence in 18 public hospitals listed in the Sichuan Province. The results showed that the effect of regulating the levels of prices was reasonable and effective, but was sig-nificantly affected by the internal and external factors. The internal factors have been found to be the medical and clini-cal technologies, and the grade and scale acted as external ones. This paper suggested that the price department should pay more attention on the levels of prices, and hence made a reasonable reform project for the prices by taking the scale of adjustment of prices into account.

Exploration and practice of the public hospital medical service price reform in Zhejiang Province / 中国卫生政策研究

Since the launch of the comprehensive public hospital reform in Zhejiang Province, the price of medical services has been adjusted, and the charging structure of medical services has been improved. Likewise, medical insurance policies have been optimized. Through several price adjustment strategies, such as the“loosen-re-strain” policy, the labor of medical personnel has been better valued, the operation of public medical institutions has been stabilized, and the allocation of medical resources has been optimized. Hence, this paper aims to measure the achievements and drawbacks of the medical service price adjustments by analyzing the various strategy. It is suggested that the comprehensive public hospital reform should be further intensified via the advancement of coordination of healthcare, medical insurance and medicine, the exploration of new procurement mechanisms for drugs and medical equipment, the establishment of dynamic adjustment mechanisms for medical service pricing, the exploration of new management mechanisms for medical services, and the strengthening of medical service supervision.

Analysis on Pricing Method of Medical Service Item in China / 中国卫生经济

With the publish of National Medical Service Pricing Item Regulation(2012 edition), a new round of medical service items matching and pricing work across the country. Under the guidance of new pricing elements and pricing policy, to actively discuss on designing more scientific pricing method. Based on the field survey and qualitative interviews, several main pricing methods currently used in China were summarized to analyze the advantages and disadvantages of these methods.

Study on the Weights Calculation Methodology of Constituted Factors of Medical Service Price Project in 2012 Edition / 中国卫生经济

Objective: To develop price framework of medical service price project and introduce the weights calculation method of the new edition medical service price project. Methods: According to the new instruction manuals of medical service price and the research of the resource costs based on the relative value(RBRVS)of the U.S. Health Care Financing Administration (HCFA) and the American Medical Association ( AMA ) , an analysis framework and dimension of medical service price was raised and authoritative international medical service project price methods w ere summarized. Results: Based on the percentages of constituted factors and the professional features, it found the weights calculation model could be constructed with the weights model, and it could calculate the weights of the elements. Conclusion: Medical service price can be measured and comprehensively researched from the different dimensions of the medical service price, so as to carry out the pricing work of medical service price project and provide better service for pharmaceutical reform.