Simulation Research on Mean Medical Expenses of "Abolishing Drug Addition and Setting Medical Service Cost":Based on the Empirical Analysis of a Tertiary Hospital

doi:10.7664/CHE20171204

Abstract：Objective:To practically simulate the mean medical expenses of outpatient and inpatient according to the coming National policy of "abolishing drug addition and adding medical service fees".Methods:The data came from a tertiary hospital in Yangzhou,Jiangsu which included outpatient and inpatient medical expenses during 2005 to 2015.Using the standards in Beijing City and the method in Baoji,Shaanxi,it set Plan 1 and Plan 2 respectively.The indexes included mean medical expenses,drug proportion,patient flow and compensation.The SAS 9.3 Statistical Software was applied to collect and analyze the data.Results:(1) The results from Plan 2 were lower than the actual expenses.It showed that the lost was caused by policy related losses,which should be supported by the local government.But the results from Plan 1 were higher than the actual expenses.It meant that the standard of medical service fee should be cut.(2) Taking the actual expenses of outpatient and inpatient as standard,it formulated Plan 3 and Plan 4.The relative average error were 7.99％ and 2.47％,which were closed to the actual expenses.(3) After adjustment of the hospital policy,the outpatient service reduced by 14.05％,among which the specialist clinics reduced by 14.61％,the general service reduced by 3.96％.(4) Both of the Plan 1 and Plan2 medical insurance fund compensation percentage were higher than before.Conclusion:The formulation and implementation of the new medical program effectively alleviated the situation of difficulty of getting specialist and made drug proportion reduce.However,the government should also pay attention to the policy related losses caused by the implementation of the new policy.It was necessary to formulate compensation schemes according to the local conditions.