Objective To explore the subdivision method of diagnosis-related group (DRG) by case-mix payment, and provide reference for reasonable imbursement mechanism and standard for DRG grouping, as well as disease cost accounting and performance assessment for hospitals. Methods The first page data of medical records of 17010 inpatients with uterine fibroids in Obstetrics and Gynecology Hospital of Fudan University from 2019 to 2021 were included. Based on the disease and treatment, combined with the length of hospital stay, other diagnosis and other factors, nonparametric test and generalized linear model were used to explore the factors affecting hospitalization expenses. Decision tree model was performed to yield case-mix related groups and predict the cost. Results The inpatients with uterine fibroids were classified into 13 groups in decision tree model based on the main surgical methods, other surgical types, and length of hospital stay. The reduction in variance was 0.34, and the coefficient of variation was 0.19-0.88. Conclusions The case-mix payment approach based on the decision tree model as the grouping method is more consistent with the actual clinical diagnosis and treatment of uterine fibroids, and can be used as method reference for the subdivision of DRG. Under the background of DRG, subdivision of DRG can provide decision-making basis for refined hospital management, including in-hospital cost accounting and performance allocation.
The purpose of this paper is to discuss the evaluation standard of rationality of medical examination from different perspectives, so as to provide theoretical evidence for medical department to establish the evaluation standard of the rationality of medical examination. By researching the relevant literature in the field of rational medical examination and combing the existing research results, this paper discusses the evaluation criteria of the rationality of medical examination from four dimensions: technology, ethics, law, and health economy. The following four suggestions are proposed for the current status of medical examination: construct clinical pathway management to avoid excessive medical examination; establish the internal supervision and evaluation mechanism to improve the professional quality of medical staff; improve medical examination-related policies, laws, and regulations, carry out specialized legislation; apply diagnosis-related group payment method, control the cost of medical examination.
With the aggravation of population aging, the medical and care needs of the elderly have increased significantly. Nowadays the integrated elderly care and medical services have been greatly promoted and various services modes have been developed in different regions. In order to promote the healthy development of integrated elderly care and medical services in China, we summarized the practical experience of integrated elderly care and medical services implemented in various parts of China, including six typical service modes such as elderly care in medical services, medical care in elderly care, cooperation between medical services and elderly care, community radiation, family doctor embedded and “Internet+”. Moreover, we compared their providers, service methods, construction specifications, service standards, regulatory agencies and payment methods. Finally, we analyzed the problems and their causes, and proposed corresponding improvements for outstanding problems in the practice of integrated elderly care and medical services in China.
With the increasing application of medical examination in clinical diagnosis and treatment, the contradiction between the diversified demands of medical examination and the shortage of resources has gradually become prominent, and it is extremely urgent to establish the control mechanism of medical examination. This paper summarizes the present situation of medical examination and its control mechanism, sorts out the basic conditions for establishing a medical examination control mechanism from the aspect of establishing the medical examination standards of rationality, perfecting the supervision system and promoting the reform of supporting systems, and puts forward main obstacles to establishing a medical examination control mechanism. It is expected to provide a reference policy basis for the establishment of the medical examination control mechanism, improving the rational use of medical resources, and promoting the development of medical examination.
Objective To systematically review the current situation, dilemmas and countermeasures of the regulation of health care integration services in China, and provide reference for the research on the regulation of health care integration services in China. Methods Studies and policies on the regulation of health care integration services were systematically searched from the inception of the databases to October 2022, and the included studies and policies were coded and analyzed by using the qualitative analysis software NVivo12. Results A total of 12 research articles and 15 policy announcements were included. The theoretical framework, regulatory dilemmas and regulatory countermeasures for the regulation of health care integration services were obtained through open coding, axial coding and selective coding. The regulatory framework of health care integration services was divided into five aspects: regulatory basis, regulatory subject, regulatory object, regulatory content and regulatory methods. The lack of regulatory basis led to dilemmas in the remaining aspects accordingly. Conclusion The regulation of health care integration services needs to start from the regulatory basis, introduce and improve the health care integration laws and policies, and gradually form a health care integration service regulatory model with institutional self-regulation as the priority, government regulation as the main body, and the public, third parties and other social regulation as the auxiliary.
Objective To review the literature written in English on hospital performance research and provide theoretical and practical references for research in the field of hospital performance in China. Methods Literature related to hospital performance published from 1972 to 2022 in the Web of Science Core Collection was retrieved. Microsoft Excel 2021 was used to analyze the annual publication volume of English literature in the field of hospital performance. CiteSpace 6.1.R6 software was used for co-occurrence analysis of countries/regions, institutions and authors, research hotspots and frontiers. Results A total of 1447 articles were ultimately included. The analysis of annual publication volume showed that the overall publication volume in the field of hospital performance was on the rise. The co-occurrence analysis of countries/regions indicated that the United States had the highest output of academic papers (548), followed by the United Kingdom and China (120 and 89 respectively). The most productive institution was Harvard University in the United States, and the most productive scholar was Harlan M. Krumholz from the Yale University School of Medicine in the United States. The most frequently occurring keyword was “care”. The clustering analysis of keywords revealed that the keywords in the field of hospital performance research were clustered into 12 categories. The top 5 keywords with the highest burst intensity included “acute myocardial infarction” “indicator” “US hospital” “predictor” and “administrative data”. Keywords such as “public hospital” “financial performance” “performance measurement” “framework” and “organizational performance” began to emerge in 2020 and had continued to the present. Conclusions The research hotspot in the field of hospital performance has shifted from focusing on individual performance to organizational performance. There is still a lot of room for research in this field in China, and the exploration of hospital performance evaluation and management models may continue to be research hotspots in this field in the future.
In the context of actively coping with aging, China has introduced a series of health care integration policies. Using the advocacy coalition framework theory, this paper aims to analyze the process of health care integration policy changes in China from three dimensions: policy beliefs, external events and policy learning. The policy subsystem of health care integration in China includes two coalitions: top-down cascade promotion and bottom-up absorption and radiation. External events and policy learning triggered policy change, where policy learning included endogenous learning within the coalition and exogenous learning between the coalitions. A policy impasse occurs when the two advocacy coalitions are at odds, and policy brokers and professional forums can get rid of the policy impasse. In the process of policy change in China’s health care integration, the two major advocacy coalitions have reached a certain consensus. It is recommended to alleviate the problems in the integration of health care by strengthening the external factors in the change of health care policy, enhancing the policy learning in the change of health care policy, and making full use of the information resources in the change of health care policy, so as to promote the high-quality development of the integration of health care.
Aiming at the shortcomings in the theory and practice of integrated elderly care and medical services in China, using the methods of literature analysis and comparative analysis, we summarize four typical models of integrated elderly care and medical services, namely, the American commercial pension model, the British national tax financing system pension model, the Japanese national security transformation, and the German long-term care insurance system, and compare the four models systematically from the aspects of system overview, service principle, operation mode, financing supervision, etc. The enlightenment for the policy and practice development of integrated elderly care and medical services in China is obtained: firstly, the service concept should be innovated; secondly, it is important to improve the relevant legal protection and supporting measures; thirdly, the refinement of the integrated elderly care and medical service projects are supposed to be promoted; fourthly, a multi-party linkage mechanism ought to be establishd; and fifthly, community endowment model should be advocated.
Objective To review the research hotspots and cutting-edge dynamics in the field of hospital operations management, providing references for relevant research in our country. Methods Using CiteSpace 6.1.R6 software, we conducted a visual analysis of English literature in the field of hospital operations management collected from the Web of Science database Core Collection from the establishment of the database to December 31st 2022. Result A total of 808 articles were included, with the first article in the field of hospital operations management published in 1980 since the establishment of the Web of Science database. Over the 42-year period, annual publications had shown an increasing trend. Research outcomes were concentrated in institutions and researchers from Europe and the United States, but academic collaboration among institutions and authors was not particularly close. The hotspots in related fields mainly focused on aspects of care quality, management, and performance. Conclusions Studies on hospital operations management in China are in the early stage, and the international influence of research outcomes needs to be further strengthened. The research frontier has shifted from healthcare quality and safety to internal financial performance, human resource management, and resource allocation. Research on the application of technological methods in hospital operations management will continue to emerge.
ObjectiveTo measure the total factor productivity and its component changes of public secondary general hospitals in China from 2012 to 2018.MethodsFrom February to September in 2019, stratified systematic sampling method was used to collect the panel data of input and output indicators from 2012 to 2018 of 511 public secondary general hospitals in 5 provinces of China (Shandong, Hubei, Hainan, Anhui, and Shanxi), and Bootstrap-Malmquist-data envelopment analysis was used to calculate the total factor productivity and its component changes of the hospitals.ResultsFrom 2012 to 2018, the total factor productivity of the 511 public secondary general hospitals decreased by 0.22%, technical efficiency decreased by 5.24%, technical changes increased by 5.29%, pure technical efficiency decreased by 1.40%, and scale efficiency decreased by 3.89%, respectively.ConclusionsIn the past 7 years, the total factor productivity of public secondary general hospitals in China has declined slightly, mainly due to the decline of scale efficiency and pure technical efficiency, and the technological progress is the main reason for its improvement. The implications for the public secondary general hospitals are three folds: avoiding blind expansion and exploring optimum scale of beds, strengthening the internal fine management to improve the management practice and technical efficiency, and promoting technological progress by healthcare cooperating organizations.