Zhao Lue-Ping, Yu Guo-Pei, Liu Hui, Ma Xie-Min, Wang Jing, Kong Gui-Lan, Li Yi, Ma Wen, Cui Yong, Xu Beibei, Yu Na, Bao Xiao-Yuan, Guo Yu, Wang Fei, Zhang Jun, Li Yan, Xie Xue-Qin, Jiang Bao-Guo, Ke Yang
Peking University Medical Informatics Center, Peking University, Beijing, China.
PLoS One. 2013 Aug 16;8(8):e72166. doi: 10.1371/journal.pone.0072166. eCollection 2013.
With market-oriented economic and health-care reform, public hospitals in China have received unprecedented pressures from governmental regulations, public opinions, and financial demands. To adapt the changing environment and keep pace of modernizing healthcare delivery system, public hospitals in China are expanding clinical services and improving delivery efficiency, while controlling costs. Recent experiences are valuable lessons for guiding future healthcare reform. Here we carefully study three teaching hospitals, to exemplify their experiences during this period.
We performed a systematic analysis on hospitalization costs, health-care quality and delivery efficiencies from 2006 to 2010 in three teaching hospitals in Beijing, China. The analysis measured temporal changes of inpatient cost per stay (CPS), cost per day (CPD), inpatient mortality rate (IMR), and length of stay (LOS), using a generalized additive model.
There were 651,559 hospitalizations during the period analyzed. Averaged CPS was stable over time, while averaged CPD steadily increased by 41.7% (P<0.001), from CNY 1,531 in 2006 to CNY 2,169 in 2010. The increasing CPD seemed synchronous with the steady rising of the national annual income per capita. Surgical cost was the main contributor to the temporal change of CPD, while medicine and examination costs tended to be stable over time. From 2006 and 2010, IMR decreased by 36%, while LOS reduced by 25%. Increasing hospitalizations with higher costs, along with an overall stable CPS, reduced IMR, and shorter LOS, appear to be the major characteristics of these three hospitals at present.
These three teaching hospitals have gained some success in controlling costs, improving cares, adopting modern medical technologies, and increasing hospital revenues. Effective hospital governance and physicians' professional capacity plus government regulations and supervisions may have played a role. However, purely market-oriented health-care reform could also misguide future healthcare reform.
随着市场经济和医疗改革的推进，中国公立医院面临着来自政府监管、公众舆论和资金需求等前所未有的压力。为适应不断变化的环境并跟上医疗服务体系现代化的步伐，中国公立医院在控制成本的同时，正在扩大临床服务并提高服务效率。近期的经验对于指导未来的医疗改革具有宝贵的借鉴意义。在此，我们仔细研究了三家教学医院，以例证它们在此期间的经验。
我们对中国北京的三家教学医院2006年至2010年期间的住院费用、医疗质量和服务效率进行了系统分析。该分析使用广义相加模型测量了每次住院费用（CPS）、每日费用（CPD）、住院死亡率（IMR）和住院时间（LOS）的时间变化。
在分析期间共有651,559例住院病例。平均CPS随时间保持稳定，而平均CPD稳步增长了41.7%（P<0.001），从2006年的1531元人民币增至2010年的2169元人民币。CPD的增加似乎与全国人均年收入的稳步增长同步。手术费用是CPD随时间变化的主要贡献因素，而药品和检查费用随时间趋于稳定。从2006年到2010年，IMR下降了36%，而LOS缩短了25%。目前，这三家医院的主要特点似乎是高成本住院病例增加，同时CPS总体稳定、IMR降低且LOS缩短。
这三家教学医院在控制成本、改善医疗服务、采用现代医疗技术和增加医院收入方面取得了一些成功。有效的医院管理、医生的专业能力以及政府的监管可能发挥了作用。然而，单纯的市场化医疗改革也可能误导未来的医疗改革。
