Comparative analysis of inpatient medical services between secondary public and private general hospitals in Chengdu / 中华医院管理杂志

ABSTRACT

Objective:To evaluate and compare the inpatient medical services of secondary public and private general hospitals by using disease risk adjustment model, and to explore the application of disease risk adjustment model in medical service evaluation of different ownership hospitals.Methods:Based on 1 032 865 front pages of medical records in Chengdu in 2017 and 2018, a regression model with mortality, average length of stay, total hospitalization expenses, medical service fees, drug costs and surgical consumables costs as dependent variables and related influencing factors as independent variables was established by using disease management intelligent analytic and evaluation system. The risk adjusted case mix index(ACMI) was calculated. The mortality, average length of stay, hospitalization expenses and other indicators were predicted. The ratio of observed value to expected value(O/E value) of each index in public and private secondary general hospitals was obtained and compared.Results:The ACMI value of secondary public general hospital was 4.63, slightly higher than that of private hospitals(4.55). The technical difficulty and resource consumption of the public hospitals were slightly higher than that of the private hospitals.From the O/E value, the management of disease mortality, medical service fees and inpatient drug costs of secondary public hospitals was generally good, and the O/E values of hospitalization expenses of each secondary private general hospital were quite different, and there was a possibility that the costs were unreasonable. The O/E value of surgical consumables cost in secondary public general hospital was 1.54, and there was room for improvement in cost management.Conclusions:The disease risk adjustment model fully considers the characteristics of different types and severity of diseases in different institutions, which can not be simply compared. Based on individual cases, it realizes the comparability of different ownership hospitals, and provides a new means for the evaluation of medical service ability and quality.