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

ABSTRACT

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.