Intended and unintended impacts of the comprehensive reform of urban public hospitals: A mixed-method study in Hangzhou, China

Zhang, Tao; Liu, Jing; Lu, Beiyin; Yan, Zhongheng; Huang, Xiaojun; Lu, Wei

doi:10.3389/fpubh.2022.979455

Cited by 3 publications

(2 citation statements)

References 29 publications

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“…Further examination of the correlation and strength of the relationship between relative value and reformed payment prices revealed that, in comparison to the United States, the contribution of physician labor value to total surgical payment price is smaller in China (refer to Figure 4). These results can be understood in light of the characteristics of the Chinese medical price policies (19)(20)(21), which include the following: (1) Fees for professional work tend to be low in comparison to fees for materials and equipment. ( 2) The NHSIS has packaged some medical supplies with surgical procedures to control the sensible use of consumables in medical facilities.…”

Section: Sino-us Comparison Of Surgical Relative Value and Pricing: S...mentioning

confidence: 99%

The work relative value estimation assessment in China: an empirical research for common surgical procedures

Hao,

Yao,

Kong

et al. 2024

Front. Public Health

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ObjectivesChina’s National Health Service Items Standard (NHSIS) establishes a relative value system and plays an important role in pricing. However, there are few empirical evaluations of the objectivity of the NHSIS-estimated relative value.MethodsThis paper presents a comparison between physician work relative value units (wRVUs) estimates for 70 common surgical procedures from NHSIS and those from the U.S. Medicare Physician Fee Schedule (MPFS). We defined the ratio of the wRVUs for sample procedures to the benchmark procedure (inguinal hernia repair) as a standardized relative value unit (SRVU), which was used to standardize the data for both schedules. We examined the variances in the ranking and quantification of SRVUs across specialties and procedures, as well as how SRVUs impact procedure reimbursement prices between the two schedules.ResultsThere was no systematic difference between MHSIS-estimated SRVUs and MPFS-estimated, but the dispersion of MPFS-estimated SRVU was greater than that of MHSIS-estimated, and the discrepancies increased with surgical risk and technical complexity. The discrepancies of SRVUs were significant in cardiothoracic procedures. Additionally, whether SRVUs were based on MPFS or MHSIS, there was a positive association between them and payment prices. However, in terms of the impact of SRVUs on payment pricing, the NHSIS system was lower than the MPFS system.ConclusionChina has made incremental progress in estimating the relative value of healthcare services, but there are shortcomings in valuation methods and their impact on pricing. The modular assessment method should be considered as a component to optimize reform.

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Section: Sino-us Comparison Of Surgical Relative Value and Pricing: S...mentioning

confidence: 99%

The work relative value estimation assessment in China: an empirical research for common surgical procedures

Hao,

Yao,

Kong

et al. 2024

Front. Public Health

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“…In the process of DRG/DIP payment system reform, the participation and support degree of various personnel in medical institutions is an important factor affecting the reform of DRG/DIP payment system, and clinical medical personnel play a key role in the correct grouping of DRG/DIP [4,5]. The cost of medicine has a great correlation with the level of medical and health costs, which is an important factor affecting medical costs.…”

Section: Introductionmentioning

confidence: 99%

Current scenario and challenges of clinical pharmacists to implement pharmaceutical care in DRG/DIP payment hospitals in China: a qualitative interview study

Gao,

Wang,

et al. 2023

Preprint

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Purpose The Diagnosis-Related Group (DRG) or Diagnosis-Intervention Packet (DIP)payment system, now introduced in China, intends to streamline healthcare billing practices. However, its implications for clinical pharmacists, pivotal stakeholders in the healthcare system, remains inadequately explored.This study sought to assess the perceptions, challenges, and roles of clinical pharmacists in China following the introduction of the DRG or DIP payment system. Methods Qualitative interviews were conducted among a sample of clinical pharmacists. Ten semi-structured interviews were conducted, either online or face to face. Thematic analysis was employed to identify key insights and concerns related to their professional landscape under the DRG or DIP system. Results Clinical pharmacists exhibited variable awareness levels about the DRG or DIP system. Their roles have undergone shifts, creating a balance between traditional responsibilities and new obligations dictated by the DRG or DIP system. Professional development, particularly concerning health economics and DRG-based or DIP-based patient care, was highlighted as a key need. There were calls for policy support at both healthcare and national levels and a revised, holistic performance assessment system. The demand for more resources, be it in training platforms or personnel, was a recurrent theme. Conclusion The DRG or DIP system's introduction in China poses both opportunities and challenges for clinical pharmacists. Addressing awareness gaps, offering robust policy support, ensuring adequate resource allocation, and recognizing the evolving role of pharmacists are crucial for harmoniously integrating the DRG or DIP system into the Chinese healthcare paradigm.

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Can public hospital reform reduce medical resource mismatches? Evidence from China

Chai,

Liu,

et al. 2024

Health Econ Rev

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Background The mismatch of medical resources is a significant issue in global healthcare, undermining both service accessibility and system efficiency. In China, despite the implementation of the “Healthy China” strategy, persistent mismatches remain due to factors such as industrialization, urbanization, and population aging. This study empirically evaluates the impact of Public Hospital Reform (PHR) on mitigating these mismatches. Methods A Difference-in-Differences (DD) approach is applied to panel data from 300 cities spanning 2010 to 2021, using the phased implementation of PHR as a quasi-natural experiment. This allows for a comparative analysis of changes in resource allocation between cities that adopted the reform and those that did not. Quantile regression assesses the effects of PHR across varying levels of resource mismatch, while mechanism tests investigate how PHR influences mismatches through cost reduction and supply expansion. Results PHR is found to reduce medical resource mismatches by 13.9%, primarily driven by cost reductions and increased resource supply. The effects are more pronounced at both lower and higher levels of mismatch, with a limited impact at mid-levels. Furthermore, the reform’s effectiveness diminishes as it is extended to more cities, suggesting a potential saturation effect. Conclusions This study demonstrates that PHR significantly alleviates medical resource mismatches in China. The findings underscore the need to focus on cost control and resource supply in future healthcare reforms, providing key insights for policymakers in developing countries facing similar healthcare resource challenges. Supplementary Information The online version contains supplementary material available at 10.1186/s13561-024-00567-7.

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Intended and unintended impacts of the comprehensive reform of urban public hospitals: A mixed-method study in Hangzhou, China

Cited by 3 publications

References 29 publications

The work relative value estimation assessment in China: an empirical research for common surgical procedures

The work relative value estimation assessment in China: an empirical research for common surgical procedures

Current scenario and challenges of clinical pharmacists to implement pharmaceutical care in DRG/DIP payment hospitals in China: a qualitative interview study

Can public hospital reform reduce medical resource mismatches? Evidence from China

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