A STUDY ON THE RELATIONSHIP BETWEEN VARIOUS DIMENSIONS OF E- PAYMENT SYSTEM WITH DIFFERENT BENEFITS OF E-PAYMENT SYSTEM TO THE STAKEHOLDERS

The implementation of digital payment mechanism has changed the basics of money payment as a medium of exchange. The revolutionary changes that happened in the Information Communication Technology (ICT) has paved the way for drastic changes in various spheres of activities such as government to citizens government to business government to government government to employee and government to foreign trade. In line with the developments that have been taking place across the world in Electronic Payment System (EPS) changes have taken place in the UAE also. The rulers of the country are keen in establishing a high-tech oriented EPS system supported by the platform of knowledge management (KM) system. The study is an effort to explore various dimensions of EPS such as security speed ease of payment convenience and control and its importance in generating various bene?ts to the stakeholders in the form of value driven bene?ts citizen driven bene?ts economic cost driven bene?ts and technology driven bene?ts. The study attempts to ?nd out the relationship between various dimensions of EPS on stakeholders bene?t in the UAE.

Analysis on the implementation effect of single disease payment policy for day surgery based on difference-in-differences model / 中华医院管理杂志

Objective:To analyze the implementation effect of single disease payment policy for day surgery (hereinafter referred to as the policy), for references for the reform of medical insurance payment.Methods:By collecting the information of inpatients from 2017 to 2019 in a tertiary hospital, the research group took patients with colorectal benign tumor and nodular goitre as the policy implementation group and the control group respectively. 2017-2018 was the pre implementation stage of the policy, and 2019 was the post implementation stage of the policy. The difference-in-differences (DID) model was used to analyze the changes in indicators such as length of stay and hospitalization expenses after policy implementation, under whether the policy is implemented or not, as well as before or after policy implementation.Results:A total of 2 419 patients were included, including 927 patients with nodular goiter in the control group and 1 492 patients with colorectal benign tumors in the policy implementation group (688 patients before the policy implementation and 804 patients after the policy implementation). The results of DID showed that the hospital days for patients with colorectal benign tumor decreased by 56.53%, the hospitalization expenses decreased by 26.51%, the out-of-pocket expenses decreased by 26.66%, the treatment expenses increased by 11.96%, the drug expenses decreased by 50.29% and the consumables expenses decreased by 20.23% after the implementation of the policy.Conclusions:The implementation of the policy could reduce length of stay, hospitalization expenses and out-of-pocket expenses, optimize the structure of hospitalization expenses, improve the efficiency of hospital diagnosis and treatment, and help the hospital realize its transformation from a size expansion to a quality and benefit expansion.

Enlightenment of the DRG payment reform in the United States on the reform of China′s medical insurance payment methods / 中华医院管理杂志

In order to curb the excessive growth of medical expenses, the United States has initiated payment reform of diagnosis-related groups (DRG) since 1983, and developed a series of complementary measures to address issues such as overcoding and declining healthcare service quality which were exposed during the reform. The authors discussed the implementation of DRG payment reform in the United States, namely the case-mix specialization of medical institutions and the reduction of costs, as well as the relationship between the two. On this basis, the authors suggested that when implementing reforms to the medical insurance payment system in China, it is imperative to avoid such loopholes as overcoding by medical institutions and excessive pursuit of efficiency at the expense of quality control, as well as the decline of comprehensive rescue capability and quality of care incurred by the exacerbated specialization.

Game analysis on hospital outpatient payment methods of Chinese basic health insurance based on principle-agent theory / 中华医院管理杂志

As the major means of outpatient payment for basic medical insurance (the insurance for short) relies on fee-for-service, it tends to encourage unreasonable growth of medical expenses. Based on the principal-agent theory, this paper analyzed the principal-agent relationship between the insurance handling agencies and the hospitals designated by the insurance, and constructed a benefit game model of outpatient payment methods and the supporting supervision game model. This practice aims to explore the optimal and balanced benefit of the insurance payment methods and supporting supervision mechanism, and provide decision support for promoting the reform of medical insurance outpatient payment in China. The analysis results of the benefit game model of payment methods showed that a system mixing the post-payment and pre-payment could optimize and maximize the total benefits and interests of all the stakeholders within the system. Specifically, the practice recommended was a mixed payment integrating ambulatory-payment-classification, fee-for-service and global-budget-payment. The analysis of the supporting regulatory game model found that the factors that must be considered to ensure the expected utility of the above mixed payment mode as follows: the gap between the unreasonable income obtained by the hospital by out-of-control charging and the reward obtained by under-control charging, the size of the penalty after the unreasonable income of the hospital was discovered, the size of the regulatory cost and the loss of benefits of the government and the insured group. It is suggested to adopt the mixed payment method mainly based on the ambulatory-payment-classification supported by fee-for-service and global-budget. At the same time, medical insurance agencies can improve their supervision mechanism from such aspects as perfecting penalties, reducing supervision costs, leveraging government administrative power and advocating public supervision.

Comparing financing models for supplementary healthcare in appendectomy: activity-based costing (fee-for-service) vs. diagnosis related group remuneration (bundled payment): a systematic review and meta-analysis

Purpose: In Brazil, healthcare services traditionally follow a fee-for-service (FFS) payment system, in which each medical procedure incurs a separate charge. An alternative reimbursement with the aim of reducing costs is diagnosis related group (DRG) remuneration, in which all patient care is covered by a fixed amount. This work aimed to perform a systematic review followed by meta-analysis to assess the effectiveness of the Budled Payment for Care Improvement (BPCI) versus FFS. Methods: Our work was performed following the items of the PRISMA report. We included only observational trials, and the primary outcome assessed was the effectiveness of FFS and DRG in appendectomy considering complications. We also assessed the costs and length of hospital stay. Meta-analysis was performed with Rev Man version 5.4. Results: Out of 735 initially identified articles, six met the eligibility criteria. We demonstrated a shorter hospital stay associated with the DRG model (mean difference = 0.39; 95% confidence interval ­ 95%CI ­ 0.38­0.40; p < 0.00001; I2 = 0%), however the hospital readmission rate was higher in this model (odds ratio = 1.57; 95%CI 1.02­2.44, p = 0.04; I2 = 90%). Conclusions: This study reveals a potential decrease in the length of stay for appendectomy patients using the DRG approach. However, no significant differences were observed in other outcomes analysis between the two approaches.

Healthcare providers' satisfaction with participation in private health insurance scheme in a city in the southern Nigeria

Health insurance coverage in Nigeria is still very low as over 70% of health care expenditure is financed by out-of-pocket payment. Health care providers are critical participants in the private health insurance scheme, therefore, their perception and satisfaction with the scheme is fundamental in ensuring sustainability. This study assessed health providers' satisfaction with private health insurance scheme in Port Harcourt Rivers State.Method: A descriptive cross-sectional study which engaged a two-stage sampling method to recruit 60 participating health facilities and 180 responding health personnel by simple random sampling at each stage. A structured, pretested interviewer-administered questionnaire was used to collect data on the levels of satisfaction with the four major domains of satisfaction viz; billing rate, payment models, HMO administrative processes and claims management. Data was analysedusing of SPSS, version 26. Characteristics of the responding facilities were tabulated and compared. Level of satisfaction was deduced by Likert Scale according to the domains of satisfaction. Regression analysis with p-value was set at less than or equal to 0.05 was used to determine the predictors of satisfaction with participation in health insurance. The level of satisfaction with negotiated billing rates, payment models, HMO administrative processes and claims management were analyseddescriptively, and results were presented as means, standard deviation, frequencies and percentages, in tables, pie and bar charts

Impact of diagnosis-related groups point payment on hospitalization costs of parturition among lying-in women / 预防医学

Objective@#To examine the effect of diagnosis-related groups (DRGs) point payment on hospitalization costs of parturition among lying-in women, so as to provide the evidence for alleviating the burdens and saving medical resources among lying-in women.@*Methods@#Lying-in women's age, gestational age, parity, duration of hospital stay, DRGs grouping and hospitalization costs were collected from the Inpatient Medical Record System and DRG Operation Analysis System in a tertiary women and children's hospital in Ningbo City from 2020 to 2021. The changes of hospitalization costs of parturition were compared among lying-in women before and after DRGs point payments, and the association between DRGs point payments and gross hospitalization costs of parturition was examined among lying-in women using a multivariable logistic regression analysis.@*Results@# A total of 11 505 lying-in women after DRGs point payments, including 6 216 women at age of 30 years and below (54.03%), and 10 871 lying-in women before DRGs point payments, including 6 208 women at age of 30 years and below (57.11%), were enrolled. The median (interquartile range) gross hospitalization expenses, material expenses and laboratory testing expenses of parturition were 8 519.19 (2 456.61), 881.38 (816.16) and 939.00 (310.00) Yuan among lying-in women after DRGs point payments, which were significantly lower than those [9 123.13 (2 660.33), 915.57 (825.26), 1 036.00 (385.00) Yuan] among lying-in women before DRGs point payments (Z=-21.971,-16.061 and -27.199, all P<0.001). Multivariable logistic regression analysis showed that DRGs point payment was statistically associated with lower gross hospitalization expenses of parturition among lying-in women after adjustment for age, duration of hospital stay, gestational age, parity, type of delivery and development of complications (OR=0.462, 95%CI: 0.432-0.494).@*Conclusion@#DRGs point payment is beneficial to reduce the hospitalization cost of parturition among lying-in women.

Study on French medical insurance payment policy for innovative medical products paid under DRG / 中国药房

OBJECTIVE To analyze the implementation experience of France’s additional list system for innovative medical products， and to provide reference for China to support medical institutions to use innovative medical products. METHODS Taking France as a case study， using policy analysis method， this paper systematically studied the practice of establishing additional list system to compensate for innovative medical products in France under diagnosis-related group （DRG） payment， including the establishment background， selection procedure and implementation effect. The suggestions were provided on the medical insurance payment methods for innovative medical products in China. RESULTS & CONCLUSIONS The additional list system established a compensation and payment system for innovative medical products with significant clinical efficacy but high treatment cost， covering four stages： application， evaluation， payment and adjustment， which effectively reduced the drug burden on medical institutions， promoted the use of innovative pharmaceutical products by medical institutions， and stimulated the innovation drive of the pharmaceutical industry， but at the same time brought payment pressure to the medical insurance fund. With the rapid spread of our DRG/diagnosis-intervention packet payment reform of China， some regions have also explored the establishment of a compensation and payment mechanism for innovative medical products， but there are still imperfections. We can refer to the implementation experience of the French additional list system and establish an effective compensation and payment system for innovative medical products starting from the establishment of selection criteria， the selection of compensation mode and the implementation of dynamic adjustment.

Challenges Faced By Customers In Adoption Of New Age Payment And Settlement System: An Empirical Study From The Banks Of Gurugram, Haryana

New Age Payment and Settlement System was introduced in banking industry to improve the service quality of banking industry. But every new technology comes with lots of challenges and banking industry is not an exception to it, so keeping this in view this research has been conducted to study the challenges faced by customers in using New Age Payment and Settlement System. The data has been collected from 312 customers with the help of semi structured questionnaire and it has been concluded that data security & privacy, phishing and lack of knowledge are the major challenges faced by customers.

Healthcare Financing in Saudi Arabia: Recent Trend and Future Challenges.

This paper provides an overview of the present healthcare financing system in the Kingdom of Saudi Arabia (KSA) and identify critical issues and challenges that need to be addressed in achieving healthcare system financing goals envisioned under the Saudi Vision-2030. This paper employed a descriptive framework based on literature review, documentation analysis, and secondary data on healthcare financing in the KSA collected from various reports. The study shows that the overall health expenditure as a percentage of Gross Domestic Product has increased from 4.4% (2001) to 6.4% (2018). The per capita expenditure on healthcare was US dollar (US$) 1484.6 in 2018, out of which the government's share was US$ 926.95. After the introduction of mandatory employer-based health insurance, the percentage of public funding on healthcare has slowly declined from 75.2% (2001) to 62.4% (2018), and out-of-pocket spending on healthcare reduced from 18.46% (2000) to 14.37% in 2018. The health financing system in the KSA faces several challenges, including health insurance coverage, access to care, equity, and quality of care.

Analysis of payment models applied to federal funding from the perspective of the Brazilian Health System

Objective: This study aims at identifying the payment methods existing in the Unified Health System referring to federal transfers to Primary Health Care (PHC) and Specialized Health Care. Methods: A quantitative and analytical study was carried out, developed in three stages: survey of all types of transfers from the Union; classification of each transfer category according to the types of payment methods and measurement of the participation of each payment methods, according to the financing components analyzed, in relation to the net values transferred. Results: Federal transfers were classified into seven payment methods. For PHC, in 2020, approximately R$ 21.7 billion was calculated, including resources destined for the pandemic, and R$ 20.9 billion without considering resources to face the COVID-19 pandemic. More than 50% of the amounts used were classified as capitation, in both cases. For specialized health care, in 2019, around R$ 48.5 billion were calculated, and in 2020 more than R$ 49.2 billion. For the two years, more than 70% of the funds were allocated to fee for service. Conclusions: This study allowed for an expansion in knowledge about the allocation of resources referring to transfers from the Union to states, the Federal District and municipalities. As the payment methods are related to productivity, access and quality of the health service, knowing and identifying the most appropriate payment methods for each situation contributes to the achievement of the goals and to the mitigation of eventual losses of efficiency in the healthcare systems.

Análise dos modelos de pagamento aplicados ao financiamento federal na perspectiva do Sistema Único de Saúde / Analysis of payment models applied to federal funding from the perspective of the Brazilian Health System

Objetivo: Este estudo tem por objetivo identificar os modelos de pagamento existentes no Sistema Único de Saúde referentes aos repasses federais para a Atenção Primária à Saúde (APS) e a Atenção Especializada à Saúde. Métodos: Foi realizado um estudo quantitativo e analítico, desenvolvido em três etapas: levantamento de todos os tipos de repasse da União; classificação de cada categoria de repasse segundo os tipos de modelos de pagamentos; e mensuração da participação de cada modelo de pagamento, de acordo com os componentes de financiamento analisados, em relação aos valores líquidos repassados. Resultados: Os repasses federais foram classificados em sete modelos de pagamentos. Para a APS, em 2020, foram apurados R$ 21,7 bilhões, aproximadamente, incluindo os recursos destinados para a pandemia, e R$ 20,9 bilhões, sem considerar os recursos para enfrentamento da pandemia de COVID-19. Mais de 50% dos valores empregados foram classificados como capitação, em ambos os casos. Para a Atenção Especializada à Saúde, em 2019, foram computados em torno de R$ 48,5 bilhões e, em 2020, acima de R$ 49,2 bilhões. Para os dois anos, mais de 70% dos recursos foram destinados a pagamentos por procedimento. Conclusões: Este estudo permitiu a ampliação do conhecimento sobre a alocação dos recursos referentes aos repasses da União para estados, Distrito Federal e municípios. Como os modelos de pagamentos estão relacionados com a produtividade, acesso e qualidade do serviço de saúde, conhecer as formas de pagamento e identificar a mais adequada para cada situação contribui para o alcance das metas e para a mitigação de eventuais perdas de eficiência nos sistemas de saúde.

Objective: This study aims at identifying the payment methods existing in the Unified Health System referring to federal transfers to Primary Health Care (PHC) and Specialized Health Care. Methods: A quantitative and analytical study was carried out, developed in three stages: survey of all types of transfers from the Union; classification of each transfer category according to the types of payment methods and measurement of the participation of each payment methods, according to the financing components analyzed, in relation to the net values transferred. Results: Federal transfers were classified into seven payment methods. For PHC, in 2020, approximately R$ 21.7 billion was calculated, including resources destined for the pandemic, and R$ 20.9 billion without considering resources to face the COVID-19 pandemic. More than 50% of the amounts used were classified as capitation, in both cases. For specialized health care, in 2019, around R$ 48.5 billion were calculated, and in 2020 more than R$ 49.2 billion. For the two years, more than 70% of the funds were allocated to fee for service. Conclusions: This study allowed for an expansion in knowledge about the allocation of resources referring to transfers from the Union to states, the Federal District and municipalities. As the payment methods are related to productivity, access and quality of the health service, knowing and identifying the most appropriate payment methods for each situation contributes to the achievement of the goals and to the mitigation of eventual losses of efficiency in the healthcare systems.

Oportunidades e desafios da saúde baseada em valor: como o Brasil pode aprender com a experiência dos Estados Unidos / Opportunities and challenges of value-based healthcare: how Brazil can learn from the United States' experience

O movimento em direção à saúde baseada em valor é uma evolução que ocorre em muitas nações do mundo. O crescimento populacional, o aumento da expectativa de vida e o custo crescente com uma saúde de alta tecnologia exigem que os pagadores públicos e privados de todo o mundo criem novas maneiras de garantir que os gastos com saúde sejam feitos nas intervenções de maior impacto. Nesse ponto de vista, apresentamos o caso da transformação da saúde baseada em valor, que está atualmente em sua infância no Brasil. O Brasil possui pagadores públicos e privados e ainda paga os serviços na maioria das vezes no modelo de pagamento por procedimento. Comparamos isso com a experiência recente nos Estados Unidos, onde a saúde baseada em valor está, de maneira lenta, mas segura, se tornando a norma. O Sistema de Saúde Brasileiro tem muitas oportunidades de aprender com a mudança ocorrida nos EUA para um modelo de saúde baseado em valor ­ incluindo o desenvolvimento de medidas de qualidade, a transição para pagamento baseado em valor e a melhoria dos dados para avaliar o desempenho nos sistemas de saúde brasileiros. As indústrias de produtos farmacêuticos no Brasil também podem desempenhar um papel, com acordos baseados em valor e parcerias com pagadores. Cada nação seguirá seu próprio caminho para uma saúde baseada em valor, mas a oportunidade de aprender um com o outro possibilita melhores chances de sucesso.

The movement toward value-based care is an evolution occurring in many nations of the world. The increasing population, longer life expectancy, and rising cost for high-tech care necessitates that government and private payers around the world devise new ways to ensure that healthcare dollars are spent on the most impactful interventions. In this viewpoint, we present the case of the value-based care transformation that is currently in its infancy in Brazil. Brazil has a mix of private and public payers but still largely reimburses based on a fee-for-service model. We contrast that with recent experience in the United States, where value-based care is slowly but surely becoming the norm. The Brazilian system has many opportunities to learn from the US shift to value-based care ­ including the development of quality measures, transition to value-based payment, and leveraging data to rank performance across Brazilian health systems. Pharmaceutical manufacturers in Brazil can play a role as well, with value-based agreements and partnerships with payers. Each nation will travel on its own path to value-based healthcare, but the opportunity to learn from each other presents one of the best chances for success.

Research progress and thinking on cost accounting of medical service items based on cost equivalent method / 中华医院管理杂志

Through literature research, this paper analyzed the research progress of medical service project cost accounting based on cost equivalent method. According to the calculation mode of cost equivalent value, this method could be divided into two types, namely, equivalent coefficient method and point method. This paper classified and summarized the application status of cost equivalent method in the cost accounting of medical service projects, analyzed the advantages of cost equivalent method, such as being able to consider a variety of cost drivers, concise accounting process and strong operability, discussed the existing problems of this method, and put forward suggestions for further deepening the application of cost equivalent method and strengthening hospital cost accounting, such as strengthening the summary and case publicity of cost equivalent method, reasonably combining and applying various methods, and scientifically and reasonably developing hospital cost accounting information construction, so as to help build a scientific and accurate cost accounting system for medical service project.

International experience and enlightenment of short-term payment for innovative medical technology under the DRG payment / 中华医院管理杂志

China has entered the task stage of comprehensive medical insurance payment reform, but there are problems restricting the development of innovative medical technology in the reform of diagnosis-related groups(DRG) payment system. The author introduced the international definition and scope of innovative medical technology, and summarized the preconditions and payment policy of short-term payment of innovative medical technology under the DRG payment system; And put forward suggestions in line with China′s actual situation, including clarifying the definition of innovative medical technology, setting access conditions for additional payment or actual payment, setting up special transition funds for high-value innovative drugs, clarifying the payment amount of innovative medical technology, and formulating payment strategies for innovative medical technology.

O programa Previne Brasil e seus potenciais reflexos na (re)organização da Atenção Primária à Saúde do estado do Rio de Janeiro / The Previne Brazil program and its potential effects in the (re)organization od Primary Health Care of the state of Rio de Janeiro

O principal objetivo deste estudo é documentar o processo de transição do modelo de financiamento federal da APS implantado pelo programa Previne Brasil no período 2019-2021 e as iniciativas da SES-RJ e do COSEMS-RJ frente aos potenciais reflexos na (re)organização da APS nos municípios do estado do Rio de Janeiro. A metodologia proposta é a de estudo de caso de caráter exploratório, descritivo com a combinação de diferentes métodos de pesquisa, fazendo uso de pesquisa bibliográfica e documental e de dados primários e secundários. Este estudo tem como recorte para análise dois aspectos do programa Previne Brasil: a Capitação Ponderada e o Componente Pagamento por Desempenho. A transferência regular do PAB fixo, de base per capita, foi considerada inovadora por ser a primeira prevista no SUS não atrelada à produção. Considerada alinhada com o princípio da universalidade e com a diretriz da descentralização presentes no regramento legal do SUS, suas transferências eram garantidas independentemente do modelo adotado para organização da APS pelos municípios. Sua substituição pela transferência atrelada a cadastro, prevista no Componente Capitação Ponderada do Previne Brasil pode ser vista como um retrocesso, pois nesse formato o custeio está atrelado ao cadastro realizado pelas equipes existentes em cada território, o que pode não refletir a totalidade da população nele residente. A absorção pelo componente Capitação Ponderada dos recursos do PAB variável referentes ao custeio da eSF, eAP, incremento para contratação de gerentes nas unidades básicas de saúde (UBS) e das equipes de NASF-AB provoca uma reflexão sobre a descontinuidade dos processos relevantes para a organização da APS, relacionados à continuidade do cuidado. No estado do Rio de Janeiro, um movimento sinérgico foi iniciado pelo COSEMS-RJ e pela SAPS/SES, no sentido de compreender como a nova proposta de financiamento da APS impactaria nos recursos a serem destinados aos municípios do estado em 2020. Neste sentido, foi criado um grupo de trabalho, com representantes das duas estruturas, para a discussão do Previne Brasil, que permanece ativo. Uma das iniciativas mais importantes desse grupo se dá com a confecção de Notas Técnicas, que começaram a ser produzidas ainda em 2019 para apoiar os municípios do estado na transição do financiamento federal da APS. Mesmo com toda a excepcionalidade de 2020, que foi marcado pela bem-vinda extensão dos prazos previstos, foi possível vislumbrar como teria sido esta mudança para o estado do Rio de Janeiro, já que podemos estudar os resultados numéricos alcançados em 2020 nos componentes de Capitação Ponderada e Pagamento por Desempenho e que não se refletiram em perda de recursos.

The main goal of this study is to document the process of federal financing of APS through the Previne Brasil program from the period of 2019-2021 and the initiatives from SES-RJ and COSEMS-RJ through the potential repercussions on the re-organization of APS in the Rio de Janeiro State's cities. The proposed methodology is one of a case study in exploratory and descriptive character along with a combination of different research methods, using bibliographic and documental research as well as primary and secondary data. It is emphasized that this study has as delimitation for analysis two aspects of the Previne Brasil: the Pondered Capacitation and the Component of Payment by Performance. The regular transference of fixated PAB, of per capita base was considered innovative, since it was the first provided by SUS not linked to production. Considered aligned to the principles of universality, with the directive of decentralization present in the legal regulation, as its transferences were guaranteed regardless of the adopted models for the APS' organization through the cities. It's substitution for the transference linked to registration, provided in Previne Brasil's Component of Pondered Capacitation, can be understood as a regression as in such format the cost is linked to the registration done by the existing themes in each territory, something that cannot reflect the integrality of the resident population. Absorbing the Component of Pondered Capacitation's PAB's variable resources referring to the cost of eSF, eAP, increment for the hiring of basic health units' management and the NASF-AB's teams provokes a reflection over the discontinuations of relevant processes for the APS' organization, related to the continuity of care. In Rio de Janeiro State, a synergetic movement was initiated by the COSEMS-RJ and SAPS/SES in a way of comprehending how the new financing proposal by APS would impact the resources to be destined to the state's cities in 2020. So, a work group was created, with representatives of the two structures, for the discussion of Previne Brasil, which remains active. One of the most important initiatives in such group is the creation of Technical Notes, that started being produced in 2019, to support the state's cities in the transition of APS' federal financing. Despite all exceptionality in 2020, which was well-marked by the welcome extension of provided deadlines, it was possible to glimpse how such change would have been for Rio de Janeiro State, since we can study the numerical results reached in 2020 in the components of Pondered Capacitation and Payment by Performance, and that it did not reflect on loss of resources.

Study on the current status and feasibility of payment reform for TCM dominant diseases from the perspective of clinicians / 中国药房

OBJECTIVE To understan d the c urrent situation and feasibility of payment reform for TCM dominant diseases from the perspective of clinicians ，so as to provide reference for optimizing and improving the reform scheme. METHODS A questionnaire was designed by ourselves ，and a simple random sampling method was used to select clinicians from the pilot hospitals of payment reform for TCM dominant diseases in Guizhou province to conduct a face-to-face questionnaire survey. SPSS 20.0 software was used for statistical analysis. The single-factor analysis and ordered Logistic regression analysis of multi-factor were used to analyze the influential factors of reform feasibility. RESULTS A total of 420 questionnaires were distributed in this survey，and 413 valid questionnaires were recovered ，with an effective rate of 98.3％. Totally 86.0％ of the clinicians thought that it was feasible for the reform to be carried out in their hospitals ，and 81.8％ thought that the selected TCM dominant diseases in the pilot hospitals were reasonable. After the reform was carried out ，61.0％ and 58.8％ of clinicians indicated that the daily number of patients treated in their departments and their willingness to communicate with patients increased ，respectively；60.3％ indicated that the difficulties and obstacles encountered in the reform were the complexity and diversity of TCM diseases ，for the treatment of patients with integrated traditional Chinese and Western medicine ，which was difficult to use a unified disease and surgery code to correctly code ；76.3％ indicated that the greatest advantage of the reform implementation was the improvement of medical quality ，while 54.2％ indicated that the greatest disadvantage was the excessive restriction of doctors ’autonomy. The results of multi-factor ordered Logistic regression analysis showed that changes in treatment services （changes in readmission rate of patient），the reasonableness of the selection of TCM dominant diseases ，and whether to reduce medical costs ，improve doctor-patient relationship ， and promote hierarchical treatment were the influential factors of reform feasibility after the implementation of reform （P＜0.05）. CONCLUSIONS It is feasible to carry out payment reform for TCM dominant diseases in Guizhou province ，but it is still in the exploratery stage ，and there are many factors affecting the feasibility of the reform. It is suggested that in the future ，when promoting in the whole pr ovince and even the whole c ountry，we should pay attention to selecting more and more reasonable dominant diseases for payment reform ， further standardize the diagnosis and treatment behavior of clinicians ， control the unreasonablegrowth of medical expenses ， strengthen communication between clinicians and patients， improve the accurate diagnosis rate of traditional Chinese medicine diseases ，implement hierarchical calculation of dominant diseases ，and promote hierarchical diagnosis and treatment of medical institutions.

Comparison of healthcare expenditures and self-payment among patients with lung cancer in Wenling City before and after implementation of diagnosis-related groups (DRGs) / 预防医学

Objective@#To investigate the healthcare expenditures and self-payment among patients with lung cancer in Wenling City before and after implementation of diagnosis-related groups (DRGs), so as to provide the evidence for controlling medical costs and relieving burdens of patients with lung cancer. @*Methods@#The basic data and healthcare expenditures of lung cancer patients that were definitively diagnosed from 2015 to 2019 and covered by medical insurance were captured from the cancer registration database of Wenling Center for Disease Control and Prevention and the database of chronic and specific diseases in Wenling Bureau of Medical Insurance. The changes of outpatient expenditures, inpatient expenditures and self-payments were compared before (2015-2016) and after implementation of DRGs (2018-2019) among lung cancer patients.@*Results@#Totally 4 947 lung cancer patients covered by medical insurance were enrolled in this study, including 3 052 males (61.69%) and 1 895 females (38.31%), with a mean age of (64.88±11.64) years. The annual mean healthcare expenditure was 56 675.85 Yuan per capita during the period between 2015 and 2016, in which 14.48% were outpatient expenditures and 85.52% were inpatient expenditures, and the annual mean healthcare expenditure was 38 702.94 Yuan per capita during the period between 2018 and 2019 (a 31.71% reduction as compared to that in 2015 and 2016), in which 24.49% were outpatient expenditures and 75.51% were inpatient expenditures. The proportions of outpatient expenditures, inpatient expenditures and total self-payments consisted of 25.38%, 32.49% and 29.67% of total healthcare expenditures in 2018 and 2019, which were significantly lower than those (50.84%, 50.96% and 50.95%, respectively) in 2015 and 2016 (χ2=13.741, P<0.001; χ2=7.015, P=0.008; χ2=9.340, P=0.002).@*Conclusions@#The annual mean healthcare expenditures per capita and the proportion of self-payment reduce among lung cancer patients covered by medical insurance following implementation of DRGs.

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.