Effect evaluation of comprehensive reform of medical price in urban public hospital: A case study of Nanjing city / 中国卫生政策研究

ABSTRACT

Objectives:This study aims to analyze the change of income and medical service revenue of hospi-tals in Nanjing after the comprehensive reform of the medical prices of public hospitals,evaluate the effect of compen-sation and explore the differentiated compensation plan, and provide the basis for establishing the compensation mechanism of dynamic adjustment. Methods: A total of 10 municipal-affiliated hospitals were selected to collect fi-nancial income and expenditure data for the 48 months before the reform (2011.11—2015.10) and the 12 months after the reform(2015.11—2016.10) in Nanjing,and used interrupted time series model to estimate the growth rate of drug profit and service revenue,and finally made a comparison between the counterfactual and actual figures. Re-sultsIt was found that,after the form,the drug profit decreased by 14.98%,and the service revenue increased by 24.79%. The revenue from medicines accounted for 42.7% and 36.9% before and after the reform respectively, and service for 28.9% and 30.3% respectively. The net financial aid accounted for 20.43% of the total drug-sales loss in average,and the net service revenue rate averaged 87.3% meeting the policy target,but within the 10 hospi-tals these rate ranged diversely from -21.9% to 712.5%,and 28.9% to 712.5%. The regression analysis indica-ted that the service compensation rate was significantly positively correlated with the proportion of service revenue in the total medical revenue before the reform. Conclusions:The Nanjing Pricing Reform basically achieved its desired goals of abolishing the drug-sales addition and the hospital compensation effect of 80% service +20% fiscal structure from service revenue and financial aid in average. However, the compensation differences among the hospitals are quite large with service-dependent hospitals compensated by over 400% and drug-dependent hospital less than 30%. However,for general hospitals,the compensation rated directly depended on the revenue structure before the reform and management performance and varied from 50% to 100%. The study at last gave its advices on improvement to further increase the service prices and establish a yearly-adjusted individualized compensation mechanism.