Objective To imitate and calculate the ways, input amount and feasibility of governmental compensation to municipal public hospitals in Shenyang city after abolishing drug retail mark-up policy under existing conditions, so as to provide regional demonstration for the decision-making and smooth implementation of public hospital reform. Methods The relevant information of 18 municipal public general hospitals or specialized hospitals during 2008-2010, such as annual basic numeration tables, summary and detailed statements of income and expenditure were collected, and the average data of both national and provincial hospitals in the same or similar level during 2009-2011 were retrieved from China Health Statistics Yearbook. The Questionnaire of Compensation to Medical Institutions was self-designed, distributed and reclaimed in order to get the data of respective hospitals during 2008-2010. Then the following 4 compensation ways were calculated: governmental input compensation, price compensation of medical service, pharmaceutical affairs compensation for price difference, and integrated way of the former 3 compensations; and the feasibility of compensation after health system reform was analyzed. Results a) If the drug retail mark-up policy was abolished in municipal hospitals, the total loss of hospitals would increase from RMB 200 million yuan in 2008 to approximately RMB 330 million yuan in 2010. b) The balance of payments and patient’s cost of Shenyang municipal public hospitals were basically similar to those of both national and provincial hospitals in the same level. c) As for the year of 2010, the new governmental compensation after implementation of new health system reform was at least RMB 438 million yuan, accounted for about 1.8 % of general budget expenditure in Shenyang municipal level. d) The results of the imitation and calculation of 3 price adjustment schemes of medical service showed that, only the third could completely compensate the abolition of drug retail mark-up. e) As to the pharmaceutical service charge based on compensation for pharmaceutical administration, it was RMB 115.6921 million yuan in Shenyang municipal public hospitals in 2010, and it could compensate 58.6% of the drug price difference. f) Compared with the former 3 compensation ways, the integrated compensation way could make public hospitals have general balance of payments which were RMB 115 million yuan, 172 million yuan and 268 million yuan, respectively. Conclusion a) After the abolition of the hospital expense covered by drug revenue, it is reasonable and feasible in increasing governmental compensation according to the annual depreciation cost of permanent assets, adjustment of medical service price, and increase income of pharmaceutical service. b) The second integrated scheme of comprehensive compensation schemes can make most hospitals have some favorable balance; the slightly increasing charge of medical care is affordable by patients and medical insurance departments, so it is operable. c) The successful and sustainable implementation of public hospitals compensation policy depends on the reform of both structure and mode of payment in medical insurance system.
Abstract: Objective To summarize the clinical experiences of onestage hybrid operation for treating typeB aortic dissection and aortic aneurysm involving distal aortic arch, explore the indication for this special technique and analyze shortterm followup results. Methods From October 2008 to May 2010, 16 consecutive patients received onestage hybrid operation in Fu Wai Hospital for aortic dissection or aortic aneurysm involving distal aortic arch. There were 12 males and 4 females. Their age ranged from 38.0 to 67.0 years (54.0±9.2 years). There were 14 patients of typeB aortic dissection, 1 patient of thoracic aortic aneurysm involving the aortic arch, and 1 patient of penetrating aortic ulcer. Among them, 10 were acute ones and 6 were chronic ones. Brachiocephalic artery bypass using neck incision with retrograde endovascular stent graft implantation was used. Four patients received bypass from the left common carotid artery to the left subclavian artery; 11 patients underwent bypass from the right common carotid artery to the left common carotid artery; and 1 patient had both of the bypasses. Intensive care unit(ICU) stay, hospital stay， and incidence of complications were closely monitored after operation. Computed tomography(CT) and general condition of the bypass grafts and its blood flow were followed up at three months and one year after operation. Results No death or severe complications occurred perioperatively. All onestage surgeries were technically successful with stent grafts implanted. Angiography during the operation showed 100% patency of all the bypass grafts and no obvious translocation or endoleakage of the stent grafts. One patient had mild paraplegia and recovered soon after treatment. Ventilation time of these patients was 2.010.0 hours (5.3±2.7 hours). The ICU stay was 0.0-2.0 days (1.1±0.4 days) and hospital stay was 4.0-7.0 days (5.3±0.8 days). The expenditure of blood products was 0.0-1 016.5 RMB (134.5±281.8 RMB). All patients were followed up with a followup period of 3.0 to 26.0 months (130±5.1 months). All patients recovered to normal social life. Enhanced CT scanning at three months and one year after operation showed no endoleakage or translocation of the stent grafts and 100% patency of the bypass grafts. There was no obvious change of the distal part of the dissection except some thrombosis formation in nine patients. Conclusion Onestage hybrid operation is safe and effective in shortening the duration of the operation and hospital stay, reducing the surgical trauma and sufferings of the patients, and lowering the risk of staged operations with satisfactory shortterm results. This special technique may expand the indications of simple endovascular repair. The mid and longterm results still need to be followed up.
Under the background of a series of national policies, various forms of medical association have been established in recent years. The purpose of the medical association is to promote the coordination and integration of medical services and the rational distribution of medical resources. However, the implementation effect varies greatly. In the process of construction, there are problems such as the unsynchronized coordination and operation between the upper and lower levels, the inadequate integration of resources, the differences and conflicts in information standards and even cultural concepts, which limit the construction effect of the medical association to a certain extent. In order to solve these problems and explore a better path for the construction of medical association, this paper summarizes and analyzes the integrated development and construction measures of “discipline+operation” of the First People’s Hospital of Ziyang under the “government-hospital cooperation”, hoping to provide experience and reference for the construction of medical association to a certain extent through the summary and analysis, thus contributing to the better development of the construction of medical association.
ObjectiveTo systematically review the classification system for the causes of pediatric drug shortages in China, and classify the causes of pediatric drug shortages accurately, so as to provide references for the formulation of targeted strategies. MethodsFour databases including Embase, PubMed, CBM and CNKI were searched from inception to November 2023. Quantitative research, qualitative research and mixed-method research on the causes of pediatric drug shortages in China were included. Two researchers independently screened the literature and extracted data. Based on the theory of efficient market and effective government, and according to the life cycle of the drug supply chain, the fundamental causes of drug shortages were classified and summarized by thematic synthesis. ResultsFourteen articles were included. According to the four stages of the drug supply chain (research and development, production, circulation and use), a total of 19 categories of causes of the pediatric drug shortages were summarized, including 5 categories in the research and development stage, 4 categories in the production stage, 6 categories in the circulation stage, and 4 categories in the use stage. Based on the theory of efficient market and effective government, further analysis of the causes revealed that the identified reasons could be attributed to three major fundamental causes: market failure, government failure, and other causes. Among them, 6 categories were related to market failure, 7 categories were related to government failure, and 6 categories were classified as other causes. ConclusionBased on the theory of efficient market and effective government, this study established a classification system of fundamental causes of the pediatric drug shortages, and made policy suggestions accordingly. Subsequently, the classification system established in this study can be used as references to develop targeted strategies to solve the problem of pediatric drug shortages in the life cycle of drug supply chain from government and market perspectives.