Impacts of the clinics-pharmacy separation reform on outpatient CT utilization in Beijing / 中华医院管理杂志

Objective:To analyze the impacts of the clinics-pharmacy separation reform on outpatient CT utilization and provide policy recommendations for the rational use, refined management and subsequent price adjustment for large-scale imaging equipments.Methods:The number of outpatient CT examinations of a tertiary public hospital in Beijing from January 1st, 2015 to April 30th, 2019 was collected. Data were analyzed using single-and multi-group interrupted time series analysis model(ITS), along with qualitative interviews.Results:The number of CT examinations increased by 0.216 per 100 visits after the reform( P<0.001). The trend of changes(slope)in the number of CT examinations increased by 0.012 person-times/month( P<0.001). There were no statistically significant differences in the slope change of CT examinations between patients under Urban Employee Basic Medical Insurance and those under Urban Resident Basic Medical Insurance( P=0.504). Conclusions:The reform has significantly increased the utilization of outpatient CT examinations. However, the impacts of the reform may be similar among patients covered by different insurance systems. The qualitative interviews imply it as necessary to pay attention to the overworking status of relevant practitioners and be alert to the excessive use of large-scale imaging equipments.

Influence of the clinic-pharmacy separation reform on a Beijing hospital / 中华医院管理杂志

Objective To understand the impact of the clinic-pharmacy separation reform on a tertiary hospital in Beijing.Methods In a comparative analysis,data in the HIS of the hospital were analyzed in descriptive statistics,covering such data as the number of visits,expense per visit,medical income and income structure change in the period between June and December in 2016 and 2017,and were analyzed by the methods of t test and descriptive statistics as well.Results Compared with the same period between June and December in 2016,the number of visits at its outpatient department reduced by 12.06％,expense per visit increased by 31.42 yuan (P ＜ 0.05),while the expense per visit of patients with medical insurance increased by 28.51 yuan (P ＜ 0.05) between June and December in 2017.The number of hospitalizations at the inpatient department increased by 2.94％,expense per hospitalization increased by 877.71 yuan,and that of patients with medical insurance decreased by 42.87 yuan (P ＞ 0.05)between the abovementioned periods.The case mixed index of inpatients rose by 0.01,and patient satisfaction rose by 4.22 percentage points.Conclusions This reform has reduced outpatient visits at hospitals,increased the coefficient of difficulty of hospital inpatients,and improved patients' experiences for medical services.Hospitals are recommended to further their internal management in a fine manner,and curb unreasonable growth of medical expenses.

Analysis of the performance of the"Clinic-pharmacy separation" reform at a Beijing hospital / 中华医院管理杂志

Objective To analyze the effects of the " Clinic-pharmacy separation" reform in Beijing. Methods Following the chronological order, 60-month operational data of a pilot hospital from 2012 to 2016 were analyzed. These data included medical statistics reports, financial information, HIS information,authority information,and patients′satisfaction on site. Results Pilot hospital showed that its medical work efficiency continued to grow. During 2013 -2016, its outpatients volume growth rate ranged 3.53% ~15.20%, and its number of discharged patients growth rate ranged 3. 12% -8. 48%. The hospital harvested 12.21 million yuan of converted income from September 2012 (when the reform was in place to cancel the drug markup and collect medical service fees) to August 2013,scoring a smooth shift of revenue sources. Medical insurance fund expenditure did not increase as a result. The percentage of drug expense was significantly decreased,dropping over 15% in 5 years. Outpatient drug fees and inpatient drug fees continued to decline year by year. Patients expressed higher satisfaction over medical services due to longer time of consultation with physicians. Conclusions " Clinic-pharmacy separation" reform has achieved the following objectives. The revenue is maintained stable; Patients flow is diverted under guidance, with less financial burden; and medical insurance expenditure is under control. We propose to improve the performance incentive and constraint mechanism for drug prescriptions by physicians.

DRGs-based analysis of the impacts on inpatient costs incurred by the reform of clinic-pharmacy-separation / 中华医院管理杂志

Objective To investigate the impacts on inpatient costs of a hospital in Beijing as incurred by the reform of clinic-pharmacy-separation by means of DRGs. Methods As required by BJ-DRGs, we selected DRGs grouping information and medical record homepage information of the inpatients discharged from a tertiary hospital in Beijing from January to March in 2017 ( pre-reform group ) and that from May to July in 2017 ( the post-reform group ) . Then we compared the differences of inpatient costs before and after the reform, and the inpatient cost changes of the DRGs groups. Results The median of inpatient costs before the reform was 8751. 21 yuan, and that after the reform was 8522. 07 yuan, a difference without statistical significance (P>0. 05). Of the 104 DRGs studied, cost changes were found in 28 DRGs (P<0. 05), with increases in 19 DRGs and drops in 9 DRGs groups. Conclusions The reform, though without impact on the inpatient costs, changed the makeup of costs on the other hand, especially on HJ13 and BB25 DRGs groups, worthy of attention. A dynamic tuning mechanism is thus suggested for pricing of medical services, and a fine management suggested for the hospitals to curb unreasonable growth of costs.

DRGs-based analysis of the impacts on inpatient costs incurred by the reform of clinic-pharmacy-separation / 中华医院管理杂志

Objective To investigate the impacts on inpatient costs of a hospital in Beijing as incurred by the reform of clinic-pharmacy-separation by means of DRGs. Methods As required by BJ-DRGs, we selected DRGs grouping information and medical record homepage information of the inpatients discharged from a tertiary hospital in Beijing from January to March in 2017 ( pre-reform group ) and that from May to July in 2017 ( the post-reform group ) . Then we compared the differences of inpatient costs before and after the reform, and the inpatient cost changes of the DRGs groups. Results The median of inpatient costs before the reform was 8751. 21 yuan, and that after the reform was 8522. 07 yuan, a difference without statistical significance (P>0. 05). Of the 104 DRGs studied, cost changes were found in 28 DRGs (P<0. 05), with increases in 19 DRGs and drops in 9 DRGs groups. Conclusions The reform, though without impact on the inpatient costs, changed the makeup of costs on the other hand, especially on HJ13 and BB25 DRGs groups, worthy of attention. A dynamic tuning mechanism is thus suggested for pricing of medical services, and a fine management suggested for the hospitals to curb unreasonable growth of costs.

Research of impacts on medical visit behaviors of patients due to the two reforms of the clinic-pharmacy-separation at a hospital in Beijing / 中华医院管理杂志

Objective To study the impacts and the difference made by the pilot reform and comprehensive reform of clinic-pharmacy-separation on the medical visit behaviors of outpatients in Beijing.Methods Invoice information of outpatients′ fee payment during the December 2012 reform and April 2017 reform at the hospital was collected.Information of these patients at the same time as controls was collected to analyze patients′ fee categories, so as to study the effect on the behavior of these patients.Results The outpatient visits decreased by 5.29% as a result of the pilot reform.The ratio of medical insurance patients rose by 6.86%, and that of such patients seeking only prescriptions rose by 4.30%;number of outpatient visits decreased by 2.03% after the comprehensive reform, while the ratio of medical insurance outpatients dropped by 2.61%, and those seeking prescription only dropped by 2.54%.Conclusions The comprehensive reform of clinic-pharmacy-separation has influenced the outpatient′s medical visit behavior, evidencing a positive outcome of the healthcare reform.

Analysis of the influence of clinic-pharmacy-separation reform on hospital operations and patients visits to doctors / 中华医院管理杂志

Objective To evaluate the outcomes of this reform to the hospital in the past two years.Methods Collecting such indexes as expenses composition,service volume and efficiency of the year before,the first year and the second year of the reform made at the hospital.Comparing the statistics and analyzing the effectiveness.Results Average outpatient expenses per visit and outpatient drug costs of patients with medical insurance during the two years of reform were found to be 12.03% and 5.7%respectively lower than the year before;while the average expenses per case fell by 4.08% and 2.69%respectively,with drug costs falling significantly as well.Outpatient visits fell,with steady increase of outpatients with medical insurance coverage.The distribution of outpatient visits varies significantly in terms of medical branches.There are a slight surplus of medical service charges of outpatients,and slight deficit of medical service charge of inpatients,with a smooth shift of the income makeup from dependence on drug price markup to medical service charge,and steady improvement of hospital efficiency.Conclusion The reform can alleviate patients’financial burden,encourage rational visits of doctors,promote fine management and structure adjustment,benefiting patients in the end.