Peng Jing, Zhang Mengran, Yu Pingfeng, Wang Nan
Management School of Hefei University of Technology, Hefei, 230000, Anhui, China.
School of Health Service Management, Anhui Medical University, Hefei, 230000, Anhui, China.
BMC Health Serv Res. 2018 Dec 20;18(1):990. doi: 10.1186/s12913-018-3807-1.
Single disease payment program based on clinical pathway (CP-based SDP) plays an increasingly important role in reducing health expenditure in china and there is a clear need to explore the scheme from different perspectives. This study aimed at evaluating the effect of the scheme in rural county public hospitals within Anhui, a typical province of China,using uterine leiomyoma as an example.
The study data were extracted from the data platform of the New Rural Cooperative Medical Office of Anhui Province using stratified-random sampling. Means, constituent ratios and coefficients of variations were calculated and/or compared between control versus experiment groups and between different years.
The total hospitalization expenditure (per-time) dropped from 919.08 ± 274.92 USD to 834.91 ± 225.29 USD and length of hospital stay reduced from 9.96 ± 2.39 days to 8.83 ± 1.95 days(P < 0.01), after CP-based SDP had implemented. The yearly total hospitalization expenditure manifested an atypical U-shaped trend. Medicine expense, nursing expense, assay cost and treatment cost reduced; while the fee of operation and examination increased (P < 0.05). The expense constituent ratios of medicine, assay and treatment decreased with the medicine expense dropped the most (by 4.4%). The expense constituent ratios of materials, ward, operation, examination and anesthetic increased,with the examination fee elevated the most (by 3.9%).The coefficient of variation(CVs) of treatment cost declined the most (- 0.360); while the CV of materials expense increased the most (0.186).
There existed huge discrepancies in inpatient care for uterine leiomyoma patients. Implementation of CP-based SDP can help not only in controlling hospitalization costs of uterine leiomyoma in county-level hospitals but also in standardizing the diagnosis and treatment procedures.
基于临床路径的单病种付费方案（CP-based SDP）在我国控制医疗费用方面发挥着越来越重要的作用，有必要从不同角度对该方案进行探讨。本研究以子宫肌瘤为例，旨在评估该方案在我国典型省份安徽省县级公立医院的实施效果。
采用分层随机抽样方法，从安徽省新型农村合作医疗办公室数据平台提取研究数据。计算并比较对照组与实验组之间以及不同年份之间的均值、构成比和变异系数。
实施基于临床路径的单病种付费方案后，子宫肌瘤患者次均住院费用从919.08±274.92美元降至834.91±225.29美元，住院天数从9.96±2.39天降至8.83±1.95天（P<0.01）。年度住院总费用呈非典型U型趋势。药品费用、护理费用、化验费用和治疗费用降低；而手术费和检查费增加（P<0.05）。药品、化验和治疗费用的构成比下降，其中药品费用下降幅度最大（4.4%）。材料、病房、手术、检查和麻醉费用的构成比增加，其中检查费增幅最大（3.9%）。治疗费用的变异系数下降幅度最大（-0.360）；而材料费用的变异系数增幅最大（0.186）。
子宫肌瘤患者住院治疗存在较大差异。实施基于临床路径的单病种付费方案不仅有助于控制县级医院子宫肌瘤患者的住院费用，还能规范诊疗流程。
