Containing medical expenditure: lessons from reform of Beijing public hospitals.
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ABSTRACT:
SUBMITTER: Liu X
PROVIDER: S-EPMC6598718 | biostudies-literature | 2019 Jun
REPOSITORIES: biostudies-literature
Publications
Containing medical expenditure: lessons from reform of Beijing public hospitals.
Liu Xiaoyun X Xu Jin J Yuan Beibei B Ma Xiaochen X Fang Hai H Meng Qingyue Q
BMJ (Clinical research ed.) 20190621
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Project description:BackgroundSince 2015, China has been rolling out the pricing reform for drugs and medical services (PRDMS) in the urban public hospitals in order to reduce drug expenditures and to relieve financial burdens of patients. This study aims at evaluating the effectiveness of the reform and investigating its positive impacts and unintended consequences to provide evidence basis for further policy making.MethodsThe Difference-in-difference (DID) approach was employed to analyze the reform impacts on the 31 provincial administrative areas in China based on data abstracted from China Statistics Yearbooks and China Health Statistics Yearbooks from 2012 to 2018.ResultsThe reform resulted in a decrease of 7.59% in drug cost per outpatient visit, a decrease of 5.73% in drug cost per inpatient admission, a decrease of 3.63% in total cost per outpatient visit and an increase of 9.10% in surgery cost per inpatient admission in the intervention group. However, no significant change in examination cost was found. The reduction in the medical cost per inpatient admission was not yet demonstrated, nor was that in the total outpatient/ inpatient expenses. The nationwide pricing reform for drugs and medical services in urban public hospitals (PRDMS-U) in China is demonstrated to be effective in cutting down the drug expenditures. However, the revealed unintended consequences indicate that there are still significant challenges for the reform to reach its ultimate goal of curbing the medical expenditures.ConclusionWe conclude that the pricing reform alone may not be enough to change the profit-driven behavior of medical service providers as the root cause lies in the unchanged incentive scheme for providers in the service delivery. This holds lessons for policy making of other low- and middle-income countries (LMICs) with similar health systems set up in the achievement of Universal Health Coverage (UHC).
| S-EPMC7682084 | biostudies-literature
Project description:ObjectiveThe purpose of the study on the one hand is to see different hospital organization commitment have difference, including the overall score and various dimensions, on the other hand, due to the different hospital type, its function orientation is different, the factors of the doctor organization commitment may also exist differences, so the study of another purpose is to determine for different types of hospital doctor organization commitment the focus and key groups, provide reference for the doctor incentive strategy.MethodsA total of 292 doctors in four large public hospitals in Beijing were investigated. Physicians' perceived organizational commitment was investigated using self-made electronic questionnaires. Data were analyzed by factor analysis, descriptive statistics, t-test, ANOVA, and multiple linear regression.ResultsIn the large public hospital doctor perception of the hospital commitment status, Specialized hospitals had higher overall commitment behavior scores, it is 3.47 ± 0.86; General hospital commitment behavior scored low at 3.39 ± 0.91. In the regression results, department category, working years, administrative position, and entry mode are the influencing factors of the organizational commitment of doctors in general hospitals, while in specialized hospitals, in addition to whether to hold an administrative position, entry mode, and working hours, the influencing factors also include gender, professional title and overseas learning background.ConclusionThere are differences in the perceived organizational commitment by doctors in different types of public hospitals, and different factors influencing their organizational commitment.Hospital type directly influences physicians' organizational commitment and plays a moderating role in influencing other factors. A possible solution is general hospital specialization, encouraging general hospitals to develop the dominant discipline. These findings can help healthcare service hospital executives or government policymakers understand the impact of hospital specialization strategies and develop more efficient medical staff incentive systems.
| S-EPMC10717447 | biostudies-literature
Project description:BACKGROUND:Injuries are a major public health problem, resulting in high health care demand and economic burden. They result in loss of disability adjusted life years (DALYs) and high out-of-pocket expenditure. However, there is little evidence on the economic burden of injuries in India. We undertook this study to report out-of-pocket expenditure and the prevalence of catastrophic health expenditure for injuries related hospitalizations in public sector hospitals in North India. Further, we also evaluate the determinants of catastrophic health expenditure. METHODS AND ANALYSIS:A prospective observational study was conducted. Participants were recruited from three hospitals for all injury cases. Data were collected via face-to-face baseline interviews and follow-up interviews over the phone at 1, 2, 4 and 12 months post-injury. Prevalence of catastrophic health expenditure (more than 30% of consumption expenditure) and impoverishment (International dollar 1.90) were estimated. RESULTS:Road traffic injuries (57%) were the leading cause of injury. Direct out-of-pocket expenditure for hospitalizations was INR 16,768 (USD 263) while indirect productivity loss was INR 8,164 (USD 128). The prevalence of catastrophic expenditure was 22.2% with 12.2% slipping below poverty line. Prevalence of catastrophic health expenditure and impoverishment was higher and significantly associated with poorest quintile, tertiary care hospital and increased duration of hospitalization (p< 0.001). CONCLUSION:The economic impact of injuries is notably high both in terms of out-of-pocket expenditure and productivity loss. A high proportion of households experienced catastrophic expenditure and impoverishment following an injury, highlighting need for programs to prevent injuries.
| S-EPMC6837486 | biostudies-literature
Project description:BackgroundTo analyse the changes in curative care expenditure (CCE) associated with noncommunicable diseases (NCDs) before and after the Beijing healthcare reform, thus providing a reference for the healthcare system.MethodsA total of 60 medical institutions were selected using multistage stratified cluster random sampling in Beijing, China. The records of approximately 100 million outpatients with NCDs in 2016-2018 were extracted. System of Health Accounts 2011 (SHA2011) was used to estimate the CCE. The segmented regression model was established to observe both the instant change and the slope change of intervention in interrupted time series analysis (ITSA). The study was conducted from December 2019 to May 2020 in Beijing, China.ResultsFrom SHA2011, we found that the CCE for outpatients with NCDs in Beijing were 58.59, 61.46 and 71.96 billion RMB in 2016, 2017 and 2018, respectively. The CCE continued to rise at all hospital levels, namely, tertiary, secondary, and community-level hospitals. However, the proportion of CCE in tertiary hospitals decreased. From ITSA, we can also conclude that the CCE showed a significant increasing trend change at the three hospital levels after the intervention. The drug proportion showed a significant decreasing trend change in secondary and tertiary hospitals.ConclusionsBeijing healthcare reform does have an impact on the CCE of NCDs.
| S-EPMC8487539 | biostudies-literature
Project description: Not available
| S-EPMC7251257 | biostudies-literature
Project description:OBJECTIVE:To evaluate the 2017 implementation of China's 2009 healthcare price reforms on Beijing's secondary and tertiary traditional Chinese medicine (TCM) hospitals. DESIGN:We employed a panel-interrupted time-series model with hospital fixed effects to estimate the impact of the price reforms. SETTING:Beijing, April 2014 to April 2018. PARTICIPANTS:All TCM hospitals in Beijing. OUTCOME MEASURES:Our dependent variables comprised the monthly outpatient and inpatient revenues, the number of monthly outpatient visits and inpatient admissions, the average total expenditures per outpatient visit and per inpatient admission, the average drug expenditures (except herbal medicines) per outpatient visit and per inpatient admission and the average medical service expenditures per outpatient visit and per inpatient admission. RESULTS:In tertiary hospitals, the price reforms led to significant reductions in the number of outpatient visits (23.1%), inpatients admission (4.6%) and drug expenditures (except herbal medicines) per inpatient admission (14.0%), and an instant raise in average total expenditure per outpatient (22.0%), medical service expenditures per outpatient visit (58.2%) and inpatient admission (19.0%). There was no significant association between the price reforms and the monthly outpatient and inpatient revenues. After the price reforms, the previous upward trend in medical service expenditures per outpatient visit rose more sharply (from 0.5% to 1.6%). In secondary hospitals, the price reforms decreased the level of drug expenditures (except herbal medicines) per outpatient visit (13.0%) and per inpatient admission (20.8%), but increased medical service expenditures per inpatient admission by 19.0%. CONCLUSION:The Beijing price reforms adjusted the cost structures in secondary and tertiary TCM hospitals without negatively impacting the operation of the hospitals, and through the increased hierarchical medical service fee, shifted patient choices away from tertiary to other health facilities, especially for patients with minor illnesses.
| S-EPMC6701667 | biostudies-other
Project description:BackgroundPublic hospitals deliver over ninety percent of all outpatient and inpatient services in China. Their quality is graded into three levels (A, B, and C) largely based on structural resources, but empirical evidence on the quality of process and outcome of care is extremely scarce. As expectations for quality care rise with higher living standards and cost of care, such evidence is urgently needed and vital to improve care and to inform future health reforms.MethodsWe compiled and analyzed a multicenter database of over 4 million inpatient discharge summary records to provide a comprehensive assessment of the level and variations in clinical outcomes of hospitalization at 39 tertiary hospitals in Beijing. We assessed six outcome measures of clinical quality: in-hospital mortality rates (RSMR) for AMI, stroke, pneumonia and CABG, post-procedural complication rate (RS-CR), and failure-to-rescue rate (RS-FTR). The measures were adjusted for pre-admission patient case-mix using indirect standardization method with hierarchical linear mixed models.ResultsWe found good overall quality with large variations by hospital and condition (mean/range, in %): RSMR-AMI: 6.23 (2.37-14.48), RSMR-stroke: 4.18 (3.58-4.44), RSMR-pneumonia: 7.78 (7.20-8.59), RSMR-CABG: 1.93 (1.55-2.23), RS-CR: 11.38 (9.9-12.88), and RS-FTR: 6.41 (5.17-7.58). Hospital grade was not significantly associated with any risk-adjusted outcome measures.ConclusionsGoing to a higher grade public hospital does not always lead to better patient outcome because hospital grade only contains information about hospital structural resources. A hospital report card with some outcome measures of quality would provide valuable information to patients in choosing providers, and for regulators to identify gaps in health care quality. Reducing the variations in clinical practice and patient outcome should be a focus for policy makers in the next round of health sector reforms in China.
| S-EPMC4592271 | biostudies-literature
Project description:BackgroundJob evaluation has been widely used to establish a foundation for internal equity and other human resource functions. The United Kingdom adopts the National Health Service (NHS) Job Evaluation scheme to determine the pay bands for most NHS staff and ensure equal pay for work of equal value. The challenges of recruiting and retaining physicians in Chinese public hospitals have heightened the need for a reliable job evaluation system to ensure the equality of physician compensation. The aim of this study was to construct job evaluation factors of physicians in Chinese public hospitals based on the NHS Job Evaluation scheme and to examine the reliability and validity of the established system.MethodsQuestionnaire surveys and statistical analyses were used to determine the job evaluation factors for physicians. The preliminary screening of the evaluation factors was based on a literature review, focused interviews with physicians and the Delphi method. Based on the results of preliminary screening, a questionnaire with 25 factors was designed to survey physicians regarding the importance of each factor in physician job evaluation. After the pretest, final questionnaire data were collected from 900 physicians by adopting a stratified sampling from 6 tertiary public hospitals in Beijing. A principal component analysis was used for factor extraction and structural validity analysis. The reliability was determined using Cronbach's alpha.ResultsThe results of the principal component analysis showed that the 25 physician job evaluation factors were grouped into the 5 dimensions of Task Characteristics, Knowledge, Responsibility, Effort/Environment, and Skills. The Cronbach's alpha coefficients of the five dimensions ranged from 0.841 to 0.909, which indicated a high level of reliability. The result of the factor analysis indicated fair structural validity. The content validity was established by building onto the NHS Job Evaluation scheme and other well-established job evaluation systems.ConclusionsOur study indicates that the Chinese version of physician job evaluation is an instrument with fair reliability and validity, which fully reflects the characteristics of physicians in Chinese public hospitals. This system can provide an important basis for developing a physician compensation plan and ensuring internal equity in healthcare organizations.
| S-EPMC7781376 | biostudies-literature
Project description:OBJECTIVES:To determine the appropriateness of medical imaging examinations involving radiation and to estimate the effective radiation dose and costs associated. DESIGN:Cross-sectional retrospective study. SETTING:Two Spanish public tertiary hospitals. PARTICIPANTS:2022 medical imaging tests were extracted from the radiology information system in February and March of 2014. MRI and ultrasound examinations were excluded. PRIMARY AND SECONDARY OUTCOME MEASURES:Five outcomes were set independently by at least two researchers according to four guidelines: (1) appropriate; (2) inappropriate; (3) inappropriate due to repetition, if the timing to carry out next diagnostic tests was incorrect according to guidelines; (4) not adequately justified, if the referral form did not include enough clinical information to allow us to understand the patient's clinical condition; and (5) not included in the guidelines, if the referral could not be matched to a clinical scenario described in the guidelines. We estimated the prevalence of the five categories according to relevant clinical and sociodemographic variables and the effective radiation dose and costs for each category. RESULTS:Approximately half of the imaging tests were deemed as appropriate (967, 47.8%) while one-third (634, 31.4%) were considered inappropriate. 19.6% of the effective dose and 25.2% of the cost were associated with inappropriate tests. Women were less likely than men to have an imaging test classified as appropriate (adjusted OR 0.70,95%?CI 0.57 to 0.86). Imaging tests requested by general practitioners were less likely to be considered appropriate than those requested by central services (adjusted OR 0.60, 95%?CI 0.38 to 0.93). Mammography and CT were more likely to be appropriate than conventional X-rays. CONCLUSION:There was a significant frequency of inappropriateness, which resulted in a high percentage of associated effective radiation dose. Percentage of inappropriateness depends on sociodemographic and clinical characteristics such as sex, age, referral physician and medical imaging test.
| S-EPMC5857681 | biostudies-other
Project description:ObjectiveThis study aims to explore the relationship between slack resources and cost consumption index in tertiary and secondary hospitals and to provide targeted healthcare resource utilisation recommendations for tertiary and secondary hospital managers.DesignThis is a panel data study of 51 public hospitals in Beijing from 2015 to 2019.SettingTertiary and secondary public hospitals in Beijing. Data envelope analysis was used to calculate the slack resources. Regression models were used to explore the relationship between slack resources and healthcare costs.ParticipantsA total of 255 observations were collected from 33 tertiary hospitals and 18 secondary hospitals.Outcome measuresSlack resources and healthcare costs in tertiary and secondary public hospitals in Beijing from 2015 to 2019. Linear or curve relationship between slack resources and healthcare costs in tertiary and secondary hospitals.ResultsThe cost of healthcare in tertiary hospitals has always been higher than in secondary hospitals, and the slack resources in secondary hospitals have always been worse than in tertiary hospitals. For tertiary hospitals, the cubic coefficient of slack resources is significant (β=-12.914, p<0.01) and the R2 of cubic regression is increased compared with linear and quadratic regression models, so there is a transposed S-shaped relationship between slack resources and cost consumption index. For secondary hospitals, only the first-order coefficient of slack resources in the linear regression was significant (β=0.179, p<0.05), so slack resources in secondary hospitals were positively related to the cost consumption index.ConclusionsThis study shows that slack resources' impact on healthcare costs differs in tertiary and secondary public hospitals. For tertiary hospitals, slack should be kept within a reasonable range to control excessive growth in healthcare costs. In secondary hospitals, keeping too many slack resources is not ideal, so managers should adopt strategies to improve competitiveness and service transformation.
| S-EPMC10124247 | biostudies-literature