Department of Health Policy and Management, School of Public Health, Hangzhou Normal University, Hangzhou, China.
Administrative Office, Yuebei People's Hospital, Shaoguan, China.
Front Public Health. 2022 Oct 10;10:979455. doi: 10.3389/fpubh.2022.979455. eCollection 2022.
Public hospital reform is a key area in the Chinese healthcare system reform with the aim of controlling excessive growth of medical expenditures. This study aims to evaluate the impacts of two rounds of urban public hospital reforms respectively starting in 2018 and 2019.
A mixed-method method was conducted in Hangzhou. In the quantitative phase, monthly data covering 7 provincial, 12 municipal, and 35 district hospitals from March 2017 to June 2020 was analyzed using a panel-interrupted time-series. Thematic content analysis was conducted using qualitative data collected from 32 in-depth interviews.
Quantitative data showed a considerable reduction in the proportion of drug revenue (provincial hospitals: -4.937%; municipal hospitals: -2.765%; district hospitals: -2.189%) and an increase in the proportion of consumable (provincial hospitals: = 2.025; municipal hospitals: = 0.206) and examinations (provincial hospitals: = 1.354, =0.159; municipal hospitals: = 1.179) revenue after the first reform. In post-reform 2, The respective instant decrease and increase in the proportion of consumable (provincial hospitals: -2.395%; municipal hospitals: -0.898%) and medical services (provincial hospitals: 2.115%; municipal hospitals: -2.604%) revenue were observed. Additionally, quantitative and qualitative data indicated inpatient expenditures dropped considerably after the reform. However, insufficient compensation for medical services and increased financial pressure on hospitals were repeatedly mentioned as unintended consequences in qualitative interviews.
Overall, the urban public hospital reforms in China created positive effects in adjusting hospital revenue structure and constraining soaring medical expenditures. Unintended consequences remind policymakers to establish rational and dynamic compensation mechanisms for public hospitals.
公立医院改革是中国医疗卫生体制改革的重点领域，旨在控制医疗费用的过度增长。本研究旨在评估分别于 2018 年和 2019 年启动的两轮城市公立医院改革的影响。
采用混合方法在杭州市进行。在定量阶段，使用面板中断时间序列分析了 2017 年 3 月至 2020 年 6 月期间 7 家省级、12 家市级和 35 家区级医院的月度数据。使用从 32 次深入访谈中收集的定性数据进行主题内容分析。
定量数据显示，药品收入比例（省级医院：-4.937%；市级医院：-2.765%；区级医院：-2.189%）大幅下降，而耗材（省级医院： = 2.025；市级医院： = 0.206）和检查（省级医院： = 1.354， = 0.159；市级医院： = 1.179）收入比例有所增加。改革后，在第二轮改革中，耗材（省级医院：-2.395%；市级医院：-0.898%）和医疗服务（省级医院：2.115%；市级医院：-2.604%）收入比例分别出现即时下降和增加。此外，定量和定性数据均表明改革后住院支出大幅下降。然而，在定性访谈中，受访者反复提到，医疗服务补偿不足和医院财务压力增加是改革的意外后果。
总体而言，中国城市公立医院改革在调整医院收入结构和控制医疗费用飙升方面产生了积极影响。意外后果提醒政策制定者为公立医院建立合理和动态的补偿机制。
