The operation process of a hospital is a process of resource consumption. In order to compensate the cost of consumption, it is necessary to develop a reasonable pricing mechanism of medical services. This paper discusses the pricing mechanism of medical service from the aspects of researches on the pricing mechanism of medical service in Chinese mainland, the enlightenment of the application of the pricing mechanism of medical service in Hong Kong and Taiwan, China, as well as foreign countries, and the practice of hospital price management, so as to make suggestions on the reasonable formulation of the pricing mechanism of medical service.
Objective To analyze the impact of removing medicine makeups and two rounds of medical service price adjustment reform on inpatient expenses, and to provide reference for policy-making and adjustment of hospital management strategy. Methods Select the front page data of medical records of the case hospital medical record management system from 2016 to 2018. According to the time of cancellation of drug addition and two rounds of medical service price adjustment reform, the data on the first page of medical records in the hospital medical record management system are divided into two groups, including before the implementation of the policy (2016) and after the implementation of the policy (2017-2018). Interrupted time series (ITS) was used to analyze the changes of hospitalization expenses before and after the adjustment of the policy. Results Before the implementation of the policy, the average hospitalization expenses in 2016 was (17 863.35±334.73) yuan; After the implementation of the policy, the average hospitalization expenses in 2017 was (18 066.16±398.42) yuan, and the average hospitalization expenses in 2018 was (18 238.95±258.28) yuan. ITS analysis showed that before the implementation of the policy, the average hospitalization expenses of patients increased by 26.616 yuan per month, but there was no statistical significance (P=0.323). In the month when the policy was implemented (December 2016), the average hospitalization expenses of patients decreased by 141.212 yuan, but there was no statistical significance (P=0.547). After the implementation of the policy, the slope of average hospitalization expenses of patients 22.363, and the inpatient expenses showed an upward trend, but there was no statistical significance (P=0.881). In the past three years, the drug expenses has decreased by 13.64%, the material expenses has decreased by 3.69%, and the labor expenses has increased by 12.25%. Conclusions After the removing medicine makeups and two rounds of medical service price adjustment reform, the drug expenses and material expenses decreased during hospitalization, and the labor expenses increased, but no change in hospitalization expenses.
The outpatient multi-disciplinary team (MDT) model is an important measure to improve the quality of medical services and enhance patients’ medical experience. The Second Affiliated Hospital of Zhejiang University School of Medicine has explored three types of outpatient MDT models, namely specialized disease model, self-service model, and professor team model, in order to improve the accessibility and coverage of outpatient MDT. Through practice, it has been found that the implementation of multi-type outpatient MDT models can further leverage the advantages of MDT in society, hospitals, and patients. This article will share the experience of building multi-type outpatient multi-disciplinary team models mentioned above.
ObjectiveTo systematically review the influencing factors of patients’ adoption intention toward online medical services. MethodsCNKI, VIP, WanFang Data, Web of Science, PubMed and EMbase databases were electronically searched to collect cross-sectional studies on the influencing factors of patients’ adoption intention toward online medical services from inception to August 2021. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies; then, meta-analysis was performed by using Stata 16.0 software. ResultsA total of 28 cross-sectional studies involving 10 200 patients were included. The results of meta-analysis showed that perceived usefulness, perceived ease of use, and performance expectations were highly positively correlated with adoption intention. Effort expectation, social influence, convenience, self-efficacy, perceived value, individual innovation and perceived behavior control were moderately positively correlated factors. Perceived health threat was a low positive correlation factor of adoption intention. Resistance to change and perception of risk were moderately negatively correlated. Technology anxiety was a low negative correlation factor of adoption intention. There was a highly positive correlation between adoption intention and use behavior. ConclusionCurrent evidence shows that there is a highly positive correlation between adoption intention and use behavior, influencing factors of patients’ adoption intention include perceived usefulness, perceived ease of use, perceived value, etc.
This article takes the regional cooperative medical service practice provided by the West China Hospital of Sichuan University as example, analyzes several problems with regional medical service practice in western region based on the introduction of the general situation and system of regional cooperative medical service provided by the West China Hospital. The problems are:lack of motivation to promote regional collaborative medical care, serious lag of policies, and lack of stratified configuration of tests/exams quality standards and construction standards of medical information system platform. This article puts forward the key point to promote western regional medical collaboration:strengthening government dominance, and establishing suitable medical insurance system and regional laboratory examination centre.
ObjectiveTo analyze the application status of Kanban management in medical service management at home and abroad and to provide a reference for lean medical management practice in China.MethodsUsing the bibliometric method, in China National Knowledge Infrastructure, Wanfang Database, CQVIP Journal Database, Springer Link, Embase and PubMed, we used “Kanban” and “Kanban management” as Chinese search terms, “Kanban system” and “two-bin system” as English search terms to search for literature published from 2009 to 2019. The number of articles published, institutions, authors, citation frequencies, key words, Kanban usage, and improved areas where Kanban was applied in were statistically described and analyzed.ResultsA total of 219 articles were retrieved. Of the 14 articles included in the study, 12 articles were published from 2015 to 2019, 8 articles were published by hospitals, and 9 articles were cited more than or equal to 3 times. The key words were basically the combinations of Kanban and related topics in the field of medical service management, such as quality control and improvement, ward service, high-quality care and process evaluation; 11 articles used Kanban alone. Kanban was used in medicine supply chain management, ward bed management, and material inventory management abroad; and was used in medicine management, emergency room patient management, medical staff performance management, operating room equipment management, and high-quality medical service management in China.ConclusionsKanban as a lean management method was introduced into the domestic medical field late, and the current research development is not balanced. Asa visual management tool, Kanban needs to be extended in the medical field. As a lean improvement tool, Kanban has positive significance in improving medical quality and patient satisfaction. It is suggested that researchers should not be limited to the existing applied research, and can study the application of Kanban in different medical service fields in combination with different lean management tools according to the actual situation of the hospital.
Coronavirus disease 2019 epidemic is a serious and infectious public health event that causes physical damage and may also have an impact on mental health. West China Hospital of Sichuan University combines the internet hospital platform with the traditional telephone model, establishes a new coronavirus disease 2019 intervention integration platform, and builds a new “four-in-one” medical service system, which contains epidemic consultation, psychological consultation, self-evaluation and home prevention and control. It has established a way for the public to communicate with professional, reduced the spread of coronavirus disease 2019 in space, and effectively carried out psychological decompression and comfort work, disseminated the knowledge of fighting coronavirus disease 2019, and provided medical advice. This article mainly introduces the out-of-hospital psychological intervention model of West China Hospital of Sichuan University during the coronavirus disease 2019 epidemic, and aims to provide a reference for exploring the psychological intervention methods for major public health emergencies.
Objective To provide basic data for further application of national essential medicine list (EML) in Chengdu, through a survey of key-workers or persons, who attended the lecture of EML, in charge of village town hospitals or community medical service centers, and to find out their awareness of and attitudes to the essential medicine and requirements and suggestions for EML training. Methods Based on principles and methods of modern cognitive psychology, we designed the questionnaire and carried out the survey face to face. Two people input the data independently and verified them. Proportions were used to analyze the data through the Excel software. Results (1) The proportions ofcorrect answers to the questions of essential medicine conception, use range of EML and the relationship between EML and essential insurance medicines list were 89%, 91% and 87%, respectively. (2) 46% of the persons investigated (117 persons) chose “always consider preferentially using the essential medicine when prescribing”, 31% (81 persons) “consider using the essential medicine in most cases”. (3) 41% of the persons investigated (103 persons) chose “comparatively welcome” for the EML. (4) Problems of implementing EML in village town hospitals or community medical service centers, in the order of importance decreasing, were: “income and compensation”, “awareness of the essential medicine and prescribing habit of the doctor”, “patient’s cognition of essential medicine and preference to drug use”, “safety and effectiveness of the essential medicine”, “the applicability of essential medicine ” and “the purchase and delivery of essential medicine”, respectively. (5) The ways of getting information of essential medicine were 19.6% (187 person-time) through documents, 18.6% (177 persontime) through conferences and 15.3% (146 person-time) through lectures. (6) 60% of the persons investigated (154 persons) attended training of the essential medicine once or twice. (7) 77% of the persons investigated (196 persons) were trained for less than one week for essential medicine. (8) Requirements and suggestions on the training of essential medicine: 42% (71 person-time) enlarging the targeted people, 22% (38 person-time) increasing the training time,16% (27 person-time) improving practicability and specificity of training contents, 11% (18 person-time) diversifying training ways, 9% (15 persontime) requiring “training according to needs ” which addresses specific problems after investigation. Conclusion Training of essential medicine should be strengthened for medical workers in the village town hospitals or community medical service centers, and researches should be carried out on evaluation of EML applicability, performance of EML implementation, financial aiding, income of medical worker, procurement and reimburse, etc.
Objective To understand the residents’ demands and utilization of the community health services and provide a basis for the construction of reasonable medical service system. Methods From July to September 2015, a purposive sampling questionnaire survey on general team mode service to bring benefits to the community residents was conducted in 20 provincial-level administrative regions of the country. SPSS 13.0 software was used for data analysis. Results A total of 1 300 questionnaires were distributed, and 1 273 valid questionnaires were recovered. In the 221 residents who were aware of the composition of general team, the awareness rate of general team composed of traditional Chinese medical doctors and gynaecologists/pediatricians was low (70.14%, 75.11%, respectively). The awareness rate of medical services including disease diagnosis and treatment, health consultation, health education and prescription in the 1 273 residents was 70.46%, 61.19%, 59.62% and 67.56%, respectively; the residents’ top five willing to accept medical services was prescribing medicine (77.77%), infusion (74.08%), health consultation (73.21%), health education (70.54%), and planned immunization (64.49%). The biggest change of the 433 patients with chronic diseases before and after treatment in the community was the increase in self-health management (70.67%) and the healthy lifestyle improvement (56.35%). Conclusion Community general team should be oriented by the objective needs and real demands of the residents; based on the ability of medical services supply, the adjustment of the key points of medical services should be made and the rational use of medical services should be guided for the residents.
Objective To analyze the advancement and trends of English literature on elderly integrated care, and provide a reference for related research and practice in China. Methods Web of Science database was searched for English literature on elderly integrated care published between 1977 and 2000, and then CiteSpace software was applied to analyze and graphically present the articles to understand the chronological development, publishing institutions, research hotspots, key articles and so on. Results A total of 1177 English research papers on elderly integrated care were included. The yearly quantity of articles increased significantly since 2016. More than 100 articles had origin in the Unite State of America, the Netherland, the United Kingdom, and Canada, respectively; the organizations of those researches were mainly single programs, and the research fields were relatively scattered. The high-frequency keywords of these articles were health care, quality of life, primary care, home care, community, chronic disease, long term care, mental health, etc, and the burst terms were long term care, case management, quality of life, community, rehabilitation, telehealth, all inclusive care, etc. According to the centrality of co-citation clustering, the top one article was World Report on Ageing and Health published by the World Health Organization. Conclusions Elderly integrated care has been paid increasing international attention. In recent years, integrated care, transitional care, case management and telecare have become research hotspots. With the key policies of people-centred and integrated health services, primary care, and community-level interventions, typical countries have developed basic models of elderly integrated care. The above theories and experiences can provide references for the practice of elderly integrated care in China.