Meng Qingyue, Rehnberg Clas, Zhuang Ning, Bian Ying, Tomson Goran, Tang Shenglan
Centre for Health Management and Policy, Shandong University, Jinan, China.
Health Policy. 2004 May;68(2):197-209. doi: 10.1016/j.healthpol.2003.09.010.
During the transition from a centrally planned to a market economy, China's urban health insurance system is being reformed. The control of the rapidly increasing hospital expenses will be a major determinant of the success of the reform. This study aims to examine the impact of the reform on hospital charges by comparing changes between two cities with different insurance systems and identifying determinants for those changes. Data was collected from six hospitals in two cities, one city implemented an urban health insurance reform, the other did not. Acute appendicitis and normal childbirth were used as tracers for calculating hospital charges. Methods included the retrospective review of medical records, interviews with health policy makers and hospital staff, focus group discussions, and the review of hospital and health insurance documents. The results showed that hospital charges per case of acute appendicitis and childbirth increased 101 and 94%, respectively, in the city without reform, and 41 and 34% in the city with reform, between 1995 and 1999. Health insurance arrangements and average LOS were the major determinants for hospital charges. Drugs and non-pharmacological treatments were the major service categories for charge containment. The combined measures of a single insurer, selective contracts, a new payment system, and use of an essential drug list, is regarded as the key features for an effective hospital charge control, and would appear to be successful measures for hospital expenditure containment within health insurance reform.
在从计划经济向市场经济转型的过程中，中国的城市医疗保险制度正在进行改革。控制迅速增长的医院费用将是改革成功与否的主要决定因素。本研究旨在通过比较两个具有不同保险制度的城市之间的变化，并确定这些变化的决定因素，来考察改革对医院收费的影响。数据收集自两个城市的六家医院，一个城市实施了城市医疗保险改革，另一个则没有。急性阑尾炎和正常分娩被用作计算医院收费的追踪指标。方法包括病历回顾、与卫生政策制定者和医院工作人员的访谈、焦点小组讨论以及医院和医疗保险文件的审查。结果显示，1995年至1999年间，在未改革的城市，急性阑尾炎和分娩的每例医院收费分别上涨了101%和94%，而在进行改革的城市，涨幅分别为41%和34%。医疗保险安排和平均住院日是医院收费的主要决定因素。药品和非药物治疗是控制收费的主要服务类别。单一保险人、选择性合同、新的支付系统以及使用基本药物清单等综合措施，被视为有效控制医院收费的关键特征，并且似乎是医疗保险改革中控制医院支出的成功措施。
