Progress and implications of value-based medical payment in the United States / 中华医院管理杂志

Value-based medicine is a healthcare delivery mode with the objective of obtaining better medical quality and health outcomes at a certain cost. The authors introduced the concept of value-based medicine, reviewed its background in the United States, described the transformation of payments from fee-for-service to value-based modes of the Centers for Medicare and Medicaid Services in the United States, and analyzed current challenges of value-based payment. Then the authors discussed the implications for China′s medical service providers to carry out value-based medical practice, in order to provide reference for China′s medical workers to participate in the construction of high-value medical system.

The Opaque Fight Against Price Transparency.

For those who doubt the importance of transparency in price and quality to free the market, you just have to look behind the public curtain and observe the fierceness with which the opponents of transparency are trying to keep consumers in the dark.

Practices and inspirations of the DRGs payment rate calculation for seniors medical insurance in the United States / 中华医院管理杂志

In terms of the definition of normal cases and abnormal ones, the paper systematically analyzed the DRGs payment for American seniors Medicare, focusing on the mechanism of the basic payment rate and additional payment rate for normal and abnormal cases. These experiences prompt to maintain the stability of the payment modes transition, motivate medical institutions, and pay attention to differences among such institutions for fine management of medical insurance.

Investigation on the cross-province settlement of NCMS-covered inpatients in Tianjin:hospitalization cost analysis / 中华医院管理杂志

Objective To analyze the hospitalization costs of new rural cooperative medical system (NCMS)-covered inpatients received by tertiary hospitals in Tianjin with their expenses reimbursed in other localities,for reference of policy making by government departments.Methods NCMS-covered patients who were admitted by 23 tertiary hospitals from May to October in 2017 were followed up and analyzed using their online reimbursement data.Patient expenses were compared among groups of different sources and diseases, using one-way variance analysis and LSD-t for multiple comparison.Results The online reimbursement data of 118 NCMS-covered patients from eight provinces including Liaoning province were collected.The total cost per person averaged 26 744.92 yuan,with 8 890.68 yuan reimbursed,accounting for 33.24%of the expenses incurred.Conclusions The higher proportion of the out-of-pocket payment by patients'results from such factors as higher ratio of non-covered drugs,the lower compensation rate by other provinces on expenses at tertiary hospitals,the medical charges outside the catalog and the medical materials at own expense.Therefore, the compensation policy and medical insurance payment policy should be improved to ensure that the NCMS patients enjoy more reasonable policy treatment.

El concepto de willingness-to-pay en tela de juicio: [revisión] / The willingness-to-pay concept in question: [review]

La idoneidad del concepto de willingness to pay (disponibilidad a pagar) es revisado en las evaluaciones económicas que se realizan en el campo de la salud. Por un lado, existe dentro de la literatura económica un número importante de investigadores que señalan los múltiples problemas metodológicos que entrañan las estimaciones de willingness to pay. Por otro lado, aún el debate teórico-conceptual acerca de la agregación de las preferencias individuales dentro de una demanda agregada no ésta del todo resuelto. Sin embargo, durante los últimos 20 años la estimación de la disponibilidad a pagar dentro de las investigaciones económicas ha aumentado de forma significativa, siendo en muchos casos uno de los principales factores de la toma de decisión en políticas de salud. Plantease alguna de las limitaciones de esta técnica, así como el posible efecto distorsionador que podría tener sobre las evaluaciones económicas que se realizan en el área de la economía de la salud.

The adequacy of the concept of willingness to pay within health economics evaluations is reviewed. A considerable number of researchers in the literature have pointed out multiple methodological issues involving willingness-to-pay estimates. On the other hand, the theoretical discussion about the aggregation of individual preferences within an aggregate demand remains open. However, over the last 20 years, willingness-to-pay estimates alongside health economics research significantly increased and in many cases they are one of the key factors for decision making on issues of health policies. The article describes some limitations of this approach as well as the potential distorting effect that it might have on health economics evaluations.

São revisadas as limitações do uso do conceito de willingness to pay (disposição a pagar) nas avaliações econômicas que se realizam no campo da saúde. Há na literatura econômica muitos investigadores que assinalam os múltiplos problemas metodológicos inerentes às estimações de willingness to pay. Por outro lado, o debate teórico-conceitual acerca da agregação das preferências individuais dentro de uma demanda agregada não está totalmente resolvido. Contudo, durante os últimos 20 anos, a estimação da disposição a pagar calculada pelos estudos tem aumentado de forma significativa, sendo em muitos casos um dos principais fatores de tomada de decisão em políticas de saúde. São apresentadas algumas das limitações desta técnica, assim como o possível efeito de distorção que poderia ter sobre as avaliações econômicas em saúde.