Objective To systematically review the impact of Beijing's comprehensive reform of medical consumption linkage on medical expenses, hospital services, and hospital income. Methods Databases including CNKI, WanFang Data, VIP, CBM, PubMed, and Web of Science were searched to collect empirical research on evaluating the impact of Beijing's comprehensive reform of medical consumption linkage on patient medical expenses and hospital operation (service volume and income structure) from June 15th, 2019 to August 15th, 2021. A descriptive analysis was performed after two reviewers independently screened the literature and extracted data. Results A total of 23 studies were included, and most of them found a relatively small change in the average outpatient and emergency medical expenses after the reform. However, the average inpatient expenses in some hospitals showed an increasing trend; the service volume of most hospitals increased slightly, and the income structure was optimized (e.g., surgery and other medical technology services revenue and its proportion increased). Conclusion The comprehensive reform of the medical consumption linkage in Beijing is the practice of deepening the reform of the medical service price mechanism. Based on the summary of the reform effect, it is recommended to further improve the price mechanism, improve service quality, and promote hierarchical diagnosis and treatment.
ObjectiveTo analyze the clinical effects and hospitalization costs of the enhanced recovery after surgery (ERAS) mode for patients underwent radical resection of hepatocellular carcinoma (HCC). MethodThe clinicopathologic data of adult patients who underwent radical resection of HCC in the West China Hospital of Sichuan University from January 2017 to December 2019 were collected retrospectively. ResultsA total of 1 082 patients were collected according to inclusion and exclusion criteria in this study, including 469 patients in the ERAS mode group and 613 patients in the traditional mode group. There were no significant differences in baseline data such as gender, age, body mass index, preoperative complications, operation type, and medical group between the two groups (P>0.05). Compared with the traditional mode group, the total hospitalization cost, medical service fee, examination fee, bed fee, and cooling and heating fee in the ERAS mode group were lower (P<0.05), the average total hospitalization time was shortened by about 1.2 d (P<0.01), the preoperative hospitalization time was shortened by about 0.3 d (P=0.03), and the postoperative hospitalization time was shortened by about 0.8 d (P<0.01) in the EARS mode group. There were no significant differences in the incidences of specific complications and total complications between the two groups (P>0.05). ConclusionERAS for patients with HCC might play a role in improving rehabilitation efficiency and reducing hospitalization costs.
Objective The rising medical expenditure is an international problem. By comparing theories and methods of medical expenditure control between China and the US, this paper aims to find out the medical expenditure strategies fitting for our country and to help with the new round of medical and health system reform. Methods This evidence-based research searched for literatures using the search strategy and screened literatures according to inclusion and excluding criteria. Useful information in the literatures was extracted through quantitative analysis of literature tables and descriptive statistical analysis. Results We found that the US academia showed a sustainable and steady trend of increased concern on the medical expenditure control, while the Chinese academia showed a larger volatility on it. There were some obvious differences such as reasons for expenditure increase, the reasonableness of the medical expenditure increase, and the specific methods and strategies of the medical expenditure control between Chinese and American authors. Conclusion On the one hand, the purpose of medical expenditure control is based on the different stages of development. On the other hand, the main interest group determines the main body who is responsible for the medical expenditure control. According to our national context, China should develop effective strategies and methods for medical expenditure control.
ObjectiveTo investigate old (the no less than 60-year-old) inpatient's diseases and cost constitution of a tertiary hospital in West China from 2008 to 2012, so as to provide baseline data for further research. MethodsThe case records of no less than 60-year-old inpatients in the tertiary hospital were collected from 2008 to 2012, and based on the first diagnose, the diseases were classified according to the International Classification of Diseases (ICD-10). The data including general information of the inpatients, discharge diagnosis, length of hospital stay and hospitalization costs, were analyzed using Stata10.0 software. Resultsa) The total number of old inpatients was 109 585, and male (59.57%) was more than female (40.43%). The disease spectrum included 18 categories. The percentage of old inpatients increased from 31.57% (2008) to 34.25% (2010). b) The top three systematic diseases were neoplasms, diseases of the circulatory system and diseases of the digestive; the male inpatients were more than the female; the number of inpatients who suffered from the top three systematic diseases got decreased with age increasing; neoplasm was the most common disease, there were 34 944 malignant neoplasm inpatients. c) The cumulative constituent ratio of the top five malignant neoplasms in male and female inpatients were respectively 62.51% and 49.44%; and the top five malignant neoplasms of male inpatients were malignant neoplasm of bronchus and lung, other medical care for neoplasm, malignant neoplasm of esophagus, malignant neoplasm of stomach and malignant neoplasm of prostate. The top five malignant neoplasms of female inpatients were other medical care for neoplasm, malignant neoplasm of bronchus and lung, malignant neoplasm of breast, malignant neoplasm of stomach and malignant neoplasm of cervix uteri. d) The average length of hospital stay decreased from 14.12 days to 11.00 days since 2008, and the average cost per capita increased from ￥14 044.79 yuan to ￥18 932.81 yuan since 2008. The proportion of drug cost of inpatients hospitalization cost decreased from 47.21% to 42.16% since 2008. ConclusionThe male inpatients are more than female in the tertiary hospital from 2008 to 2012. The most common systematic disease is neoplasm, especially the malignant neoplasms with higher constituent ratio. The top five malignant neoplasms of male inpatients and female are different. The average length of stay in hospitals has declined in five years, however the average cost per capita has increased.
Objective To investigate the medical charge of in-patients with diabetes and its influencing factors for effective hospital costs controlling. Methods The inpatients with diabetes (the first diagnosis was diabetes; the first three ICD-10 codes of which were between E10 to E14) in Fifth Peoples' Hospital of Chengdu during January to September of 2014 were analyzed for their hospital costs with descriptive statistical method, ANOVA and multiple linear regression method. Statistical analysis was conducted by using SPSS 18.0 software. Results A total of 1 389 cases of diabetes were included. The median of total medical costs and daily costs were 4 554.45 yuan and 446.46 yuan, respectively. The differences of total medical costs and daily costs between diabetes patients with different amount of complications were statistically significant (P<0.001). The factors including age, the way of the medical expense, the number of complications, with acute complications, CCI score and the hospital-stay length were proved to be significantly correlated to total medical costs of diabetes inpatients (P<0.05). Conclusion Age, the way of the medical expense, the number of complications, with acute complications, CCI score and the hospital-stay length are influence factors of medical costs of diabetes inpatients.
Objective To analyze the impact of removing medicine makeups and two rounds of medical service price adjustment reform on inpatient expenses, and to provide reference for policy-making and adjustment of hospital management strategy. Methods Select the front page data of medical records of the case hospital medical record management system from 2016 to 2018. According to the time of cancellation of drug addition and two rounds of medical service price adjustment reform, the data on the first page of medical records in the hospital medical record management system are divided into two groups, including before the implementation of the policy (2016) and after the implementation of the policy (2017-2018). Interrupted time series (ITS) was used to analyze the changes of hospitalization expenses before and after the adjustment of the policy. Results Before the implementation of the policy, the average hospitalization expenses in 2016 was (17 863.35±334.73) yuan; After the implementation of the policy, the average hospitalization expenses in 2017 was (18 066.16±398.42) yuan, and the average hospitalization expenses in 2018 was (18 238.95±258.28) yuan. ITS analysis showed that before the implementation of the policy, the average hospitalization expenses of patients increased by 26.616 yuan per month, but there was no statistical significance (P=0.323). In the month when the policy was implemented (December 2016), the average hospitalization expenses of patients decreased by 141.212 yuan, but there was no statistical significance (P=0.547). After the implementation of the policy, the slope of average hospitalization expenses of patients 22.363, and the inpatient expenses showed an upward trend, but there was no statistical significance (P=0.881). In the past three years, the drug expenses has decreased by 13.64%, the material expenses has decreased by 3.69%, and the labor expenses has increased by 12.25%. Conclusions After the removing medicine makeups and two rounds of medical service price adjustment reform, the drug expenses and material expenses decreased during hospitalization, and the labor expenses increased, but no change in hospitalization expenses.
Objective To explore the serious situation of injection abuse, and its influence to average prescription fee. Methods The subjects of this study were health service settings in rural area of 9 provinces/cities in Midwest of China. The treatment prescription indicators of county and village health service settings were calculated. Results Prescription injection rates of health care facility in rural area of Midwest provinces/cities of China (25.8% to 62.2%,mean: 45.1%) were higher than the standard of WHO (13.4% to 24.1%), and the injection abuse situation was serious. Injection bause caused the increase of prescription fee. Excess usage of injection in health service settings was related to the economic level of the on-site county or village, and also related to the size and load of health service facilities. Conclusion Suggestions are proposed to the government health agency according to the results of the study: enhancing the lawmaking, establishing the related policy and effective measure, training the medical personnel, promoting the mass health education, investigating the effective injection management model in rural area, and reducing the rate of injection.
Objective To analyze the crucial factors which affect the hospitalization expenses of patients with uterine adenomyosis, in order to take corresponding measures. Methods A total of 583 patients diagnosed with uterine fibroids reported by hospitals in urban areas of Suining city through hospital quality monitoring system between December 2013 and December 2015 were included in this study. The main reasons for the expense structure was described by Pareto’s law. The importance of hospitalization expense influencing factors was analyzed by neural network model, and single factor analysis was used to analyze important influencing factors of hospitalization expenses. Results The main factors influencing hospitalization expenses included length of stay in hospital, operation techniques and illness conditions, and their importance value was respectively 0.581, 0.175 and 0.088. Conclusion Based on hospitalization expenses, length of stay in hospital and expense structure, high intensity focused ultrasound therapy is more reasonable in the treatment of uterine adenomyosis.