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The Chinese experience of hospital price regulation

HEALTH POLICY AND PLANNING 2000年第2期15卷 157-163页

作者： Liu, XZ Liu, YL Chen, NS Harvard Univ Sch Publ Hlth Program Hlth Care Financing Cambridge MA 02138 USA Shandong Med Univ Inst Social Med & Hlth Policy Jinan Peoples R China

This paper analyzes the distortion effects of the hospital pricing policies in China. To help maintain equitable access to hospital services, the Chinese government regulates prices of hospital services, and provides subsidies to public hospitals. Comparing the regulated fees of selected hospital services with their average unit costs indicates that the average cost-recovery rate of the fees is only 50%, The fees for 90% of the services are less than their average unit costs, while the fees for the high-tech services exceed their costs, Moreover, the State Price Commission allowed a drug profit margin of 15-20% over the wholesale price. The distorted fee schedule affects the behaviour of hospitals. Empirical evidence revealed problems of violation of price regulations (charging a fee exceeding the regulated fee), over-provision of profitable high-tech services and over-prescription of drugs, The Chinese experience shows that low regulated fees cannot reduce the economic burden on patients, and that distorted medical fees can result in distorted service provision and low efficiency of medical resources, Strategies to correct for the price distortions are discussed.

关键词：中国费用控制/立法和法学药费支出费用医疗/统计学和数值数据卫生保健改革卫生政策/立法和法学医院收费/立法和法学医院收费/统计学和数值数据医院费用/统计学和数值数据工艺学高成本

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Probabilistic linkage of computerized ambulance and inpatient hospital discharge records: A potential tool for evaluation of emergency medical services

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ANNALS OF EMERGENCY MEDICINE 2001年第6期37卷 616-626页

作者： Dean, JM Vernon, DD Cook, L Nechodom, P Reading, J Suruda, A Univ Utah Sch Med Dept Pediat Intermt Injury Control Res Ctr Salt Lake City UT USA Univ Utah Sch Med Dept Family & Prevent Med Intermt Injury Control Res Ctr Salt Lake City UT USA

Study objectives: Emergency medical services (EMS) is an important part of the health care system. The effect of EMS on morbidity, mortality, and costs of illness is difficult to evaluate because hospital information is not available in out-of-hospital databases. We used probabilistic linkage to create such a database from ambulance and inpatient data and demonstrate the potential for linkage to facilitate evaluation of EMS responses resulting in hospital admission. Methods: Statewide ambulance and inpatient hospital discharge records were available for 1994 through 1946. Ambulance records indicating admission to the emergency department or hospital (165,649 records) were linked to inpatient hospital records indicating emergency admission (146,292 records) by using probabilistic linkage. Out-of-hospital data (dispatch code, treatments rendered, and ages), linkage rates, and inpatient data (discharge status, charges, length of stay, and payer category) were analyzed. Results: We linked 24,299 (14.7%) ambulance events to inpatient hospital discharges. If we had used exact linkage methods, we would have only linked 14,621 record pairs, a loss of nearly 40%. linkage rates were relatively constant between years (approximately 15%) but differed by ambulance dispatch codes. Out-of-hospital dispatch codes with high linkage rates included breathing problems (22.6%), chest pain (21.5%), diabetic problems (16.9%), drowning incidents (14.9%), falls (19.2%), strokes (32.8%), and unconsciousness or fainting episodes (16.1%). Linkage to the hospital record provided access to hospital outcome data. Inpatient mortality was 6.8%. Survivors were discharged home (60.7%), transferred to other acute-care facilities (3.6%) or intermediate-care facilities (23.3%), or discharged with home health care provision (4.9%). The median length of stay was 3 days, and median charges were $6,620;total inpatient charges were $286,737,067. Conclusion: Probabilistic linkage enables ambulance and hospita

关键词：救护车/组织和管理数据库管理系统可行性研究卫生服务研究/方法医院收费/统计学和数值数据医院死亡率信息系统/组织和管理住院病人/统计学和数值数据保险健康/统计学和数值数据住院时间/统计学和数值数据病案连锁/方法病案系统计算机化/组织和管理年患病率结果评价(卫生保健) 病人出院/统计学和数值数据病人转诊/统计学和数值数据概率存活率分析犹他/流行病学青少年成年人老年人老年人 80以上儿童儿童学龄前女(雌)性人类婴儿男(雄)性中年人

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Differences between patients with heart failure treated by cardiologists, internists, family physicians, and other physicians: Analysis of a large, statewide database

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AMERICAN HEART JOURNAL 2000年第3期139卷 491-496页

作者： Philbin, EF Jenkins, PL Henry Ford Hosp Sect Heart Failure & Cardiac Transplantat Div Cardiovasc Med Detroit MI 48202 USA Bassett Healthcare Mary Imogene Bassett Res Inst Cooperstown NY USA

Background The management of heart failure (HF) by cardiologists may be better than that of other physicians in that cardiologists' treatment choices more frequently conform with published guidelines and the results of clinical trials. Whether cardiologists' management of HF is more or less cost-effective is up for debate. Methods Information on all 1995 New York state hospital discharges assigned ICD-9-CM codes indicative of HF in the principal diagnosis position was obtained. Demographic and clinical characteristics, process of care, resource utilization, and short-term HF-related outcomes were compared between patients of cardiologists and patients of other physicians. Results A total of 44,926 patients were identified, with 10,506 (23%) receiving care from cardiologists, 28,300 (63%) from internists 4812 (11%) from family practitioners, and 1308 (3%) from other physicians. Patients of cardiologists were younger, more frequently male, and less frequently residents of nursing homes. They were more likely to have associated cardiovascular diagnoses but less likely to have comorbid general medical conditions. Patients of cardiologists were more likely to undergo cardiac catheterization (9%) than those of internists (3%) and family practice (2%) physicians but had similar adjusted hospital length of stay and charges. Mortality and hospital readmission rates for HF were similar among the groups. Patients in the "other" group (managed mostly by surgeons) were the youngest, underwent more invasive and cardiac surgical procedures, and had the longest length of stay and highest hospital charges. Conclusions Cardiologists' management of HF is not economically disadvantageous. The relations among physician specialty, process of care, resource utilization, and clinical outcomes require further study before rational and evidence-based health care staffing recommendations can be formulated.

关键词：心脏病学/经济学心脏病学/统计学和数值数据队列研究共病现象冠心病/流行病学数据库事实型家庭医学/经济学家庭医学/统计学和数值数据心脏导管插入术/利用心脏瓣膜疾病/流行病学医院收费/统计学和数值数据内科学/经济学内科学/统计学和数值数据肾疾病/流行病学住院时间/经济学住院时间/统计学和数值数据肺疾病/流行病学纽约比值比结果评价(卫生保健)/统计学和数值数据医师诊疗模式/统计学和数值数据患病率老年人女(雌)性人类男(雄)性

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Cost analysis of breast conservation surgery compared with modified radical mastectomy with and without reconstruction

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AMERICAN JOURNAL OF SURGERY 2000年第6期179卷 441-445页

作者： Palit, TK Miltenburg, DM Brunicardi, FC Baylor Coll Med Michael E DeBakey Dept Surg Houston TX 77030 USA

BACKGROUND: Breast conservation surgery (BCS), consisting of lumpectomy, axillary lymph node dissection, and radiation therapy, is as effective as modified radical mastectomy (MRM) for the treatment of early stage breast cancer. The costs of these treatment options have not been adequately addressed in the current era of increasing utilization of BCS and breast reconstruction. The purpose of this study is to determine differences in treatment costs among BCS, MRM alone, and MRM with reconstruction. METHODS: Patients with stage I and II breast cancer receiving inpatient treatment at a private university-affiliated hospital between January 1996 and July 1997 were analyzed (n = 230). Charges were determined as follows: inpatient and radiotherapy charges from the hospital billing department, surgeon fees from group practice billing codes, and radiotherapy physician fees from the radiation oncology group practice. Inpatient length of stay was obtained from hospital medical records. RESULTS: Average hospital inpatient charge for BCS was $4,748 (n = 74), $6,280 for MRM alone (P < 0.001, n = 132), and $11,946 for MRM with reconstruction (P < 0.001, n = 24). Surgeons' fees for BCS were $2,840, $3,500 for MRM alone, and $10,774 for MRM with reconstruction. The average radiotherapy charge was $18,742. Average length of stay was 1.03 days for BCS, 2.44 days for MRM alone (P < 0.001), and 3.71 days for MRM with reconstruction (P < 0.001). Average total cost of BCS ($26,330) was significantly greater than the average total cost of either MRM alone ($9,780, P < 0.001) or MRM with reconstruction ($22,720, P < 0.001). CONCLUSIONS: BCS is more expensive than MRM with or without reconstruction. It is the addition of radiotherapy that results in the higher total cost of CS. (C) 2000 by Excerpta Medica.

关键词：乳腺肿瘤/病理学乳腺肿瘤/外科学综合疗法成本及成本分析评价研究费用医疗/统计学和数值数据卫生保健费用医院收费/统计学和数值数据医院大学/经济学乳房切除术根治性/经济学乳房切除术根治性/方法乳房切除术区段/经济学乳房切除术区段/方法肿瘤分期概率修复外科手术/经济学修复外科手术/方法登记敏感性与特异性得克萨斯成年人老年人老年人 80以上女(雌)性人类中年人

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A state wide evaluation of appendectomy in children

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AMERICAN JOURNAL OF SURGERY 1999年第6期178卷 537-540页

作者： Kokoska, ER Murayama, KM Silen, ML Miller, TA Dillon, PA Weber, TR Cardinal Glennon Childrens Hosp St Louis MO 63104 USA St Louis Univ Hlth Sci Ctr Dept Surg Div Pediat Surg St Louis MO 63103 USA

BACKGROUND: Traditional management of appendicitis in children involves open appendectomy (OA), an operation that is relatively inexpensive and carries few risks and complications. However, little information is available regarding the use, cost, and complication of laparoscopic appendectomy (LA) in children. METHODS: Our initial aim was to determine if LA is frequently performed in children (<15 years). We then compared the surgical results of OA versus LA. In conjunction with the Missouri Department of Health, we evaluated 793 children treated for appendicitis throughout the state between January 1997 and June 1997, The authors were blinded to the patient, surgeon, and hospital;no children were excluded. RESULTS: LA was infrequently performed in children with advanced disease. Overall, children undergoing LA were older and had a shorter hospitalization but no difference in hospital charge. When separated by child age, LA was associated with a shorter length of stay in all groups (0 to 5, 6 to 10, and 11 to 15 years) but only children in the 6 to 10 year range had a lower hospital charge when compared with patients undergoing OA. CONCLUSIONS: LA is becoming a common surgical approach for older children with simple appendicitis. Furthermore, these data suggest that LA, independent of individual surgeon or medical center, is associated with a decreased length of hospitalization without a significant difference in hospital charge. Am J Surg. 1999;178:537-540. (C) 1999 by Excerpta Medica, Inc.

关键词：年龄分布阑尾切除术/方法阑尾切除术/统计学和数值数据阑尾炎/外科学评价研究医院收费/统计学和数值数据腹腔镜检查/统计学和数值数据住院时间/统计学和数值数据密苏里/流行病学青少年儿童儿童学龄前女(雌)性人类男(雄)性

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User fees and patient behaviour: Evidence from Niamey National Hospital

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HEALTH POLICY AND PLANNING 1995年第4期10卷 350-361页

作者： Weaver, M WASHINGTON UNIV DEPT HLTH SERVSEATTLEWA

Evidence is presented on the effects of price changes on the delay before seeking care and on referral status in a sample of hospital patients in Niger. Price changes are measured as differences across patients at one hospital in whether or not they pay for care, rather than as differences in prices across several hospitals. User fees are charged, but the fee system allows exemptions for some payor categories such as government employees, students, and indigent patients. Evidence is also presented on the effect of income on the delay before seeking care and referral status. The analysis demonstrates a technical point on whether household consumption or current income is a more appropriate measure of income. The analysis shows that user fees affect patient behaviour, but the effects are not the same for outpatients and inpatients. Outpatients who pay for care wait longer before seeking care, but inpatients do not. Inpatients who pay for care are more likely to be referred, but outpatients are not. Patients with more income wait less time to seek care and are less likely to be referred than other patients. Further, household consumption explains patient behaviour better than current income.

关键词：数据收集发展中国家卫生服务易得程度/经济学卫生服务易得程度/统计学和数值数据卫生服务研究/方法医院收费/统计学和数值数据医院公立/经济学医院公立/统计学和数值数据医院公立/利用住院病人/统计学和数值数据最小二乘法分析尼日尔门诊病人/统计学和数值数据病人参与/经济学病人参与/统计学和数值数据转诊和会诊时间因素人类

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