Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, 100191, China.
International Research Center for Medicinal Administration, Peking University, Beijing, China.
BMC Public Health. 2020 Apr 19;20(1):522. doi: 10.1186/s12889-020-08619-3.
The Chinese government has begun to dampen the growth of health expenditure by implementing Global Budgets (GB). Concerns were raised about whether reductions in expenditure would lead to a deterioration of quality of care. This paper aims to evaluate the impact of GB on health expenditure, service volume and quality of care among Chinese pneumonia patients.
A secondary hospital that replaced Fee-For-Service (FFS) with GB in China in 2016 was sampled. We used daily expenditure to assess health expenditure; monthly admission, length of stay (LOS), number of drugs per record and record containing antibiotics to evaluate service volume; record with multiple antibiotics and readmission to assess quality of care. Descriptive analyses were adopted to evaluate changes after the reform, logistic regression and multivariable linear regressions were used to analyze changes associated with the reform.
In 2015 and 2016, 3400 admissions from 3173 inpatients and 2342 admissions from 2246 inpatients were admitted, respectively. According to regression analyses, daily expenditure, LOS, readmission, and records with multiple antibiotic usages significantly declined after the reform. However, no significant relation was observed between GB and the number of drugs per record or record containing antibiotics.
When compared with FFS, GB can curtail health expenditure and improve quality of care. As far as service volume was concerned, LOS and monthly admission declined, while number of drugs per record and record containing antibiotics were not affected.
中国政府已开始通过实施全球预算（GB）来抑制卫生支出的增长。有人担心支出的减少是否会导致医疗质量的恶化。本文旨在评估 GB 对中国肺炎患者的卫生支出、服务量和医疗质量的影响。
我们选取了 2016 年中国一家用全球预算取代按服务项目付费（FFS）的二级医院作为样本。我们使用日均支出评估卫生支出；用每月入院人数、住院天数（LOS）、每张记录的药物数和含抗生素的记录数来评估服务量；用含多种抗生素的记录和再入院来评估医疗质量。采用描述性分析评估改革后的变化，采用逻辑回归和多变量线性回归分析与改革相关的变化。
2015 年和 2016 年，分别有 3400 人次和 2342 人次住院，来自 3173 人次和 2246 人次住院患者。根据回归分析，改革后日均支出、住院天数、再入院率和含多种抗生素使用的记录数显著下降。然而，GB 与每张记录的药物数或含抗生素的记录数之间没有显著关系。
与 FFS 相比，GB 可以控制卫生支出并提高医疗质量。就服务量而言，住院天数和每月入院人数减少，而每张记录的药物数和含抗生素的记录数没有受到影响。
