Since 2012, sanming city, fujian province, has built a price dynamic adjustment mechanism that highlights the value of health services and their systemic, sustainability of health insurance fund operations and synergies with the “three doctors”. In september 2023, saming city launched the eleventh price adjustment for medical services, further optimizing the price structure of medical services and introducing a new “window period” for optimizing the allocation of health resources。
This paper is aimed at 156 health-care institutions at different levels in saming city, and is based on data analysing the impact of the eleventh price adjustment of health-care services in saming city on different levels of health-care institutions and discussing related issues。
Analysis of digital changes and trends
Trends in income structure
In 2023, the share of income from health services rose from 32. 87 per cent in 2013 to 46. 07 per cent. The proportion of income from medical services, medical supplies and tests was estimated at 5. 02. 3. The structure of income from medicines was gradually optimized, showing the positive impact of price adjustments on optimizing the allocation of medical resources. The municipalities have done so by increasing the prices of surgical, diagnostic, nursing and clinical projects, with a relatively large number of projects。
In terms of the ratio of income to medical services, the ratio of income to medical services in level iii hospitals increased by 1. 4 per cent per month before the price policy intervention, by 1. 51 per cent per month after the price policy intervention, by 0. 68 per cent per month before the price policy intervention and by 0. 68 per cent per month after the price policy intervention. The proportion of income from primary health-care services increased by 0. 35 per cent per month before the price policy intervention and 0. 37 per cent per month after the price policy intervention. The share of income from registered visits to level ii hospitals increased by 2. 1 per cent in the month of implementation of the policy but was not translated into a long-term trend, and the share of other income did not reflect the impact of the policy。
In terms of the average cost of medication for in-patients, policy interventions increased by 16. 42 per cent at the primary level and decreased by 1. 11 per cent per month thereafter, while the cost of medicine for the third-level and second-level hospitals increased by 1. 34 per cent and 0. 97 per cent, respectively, per month, compared with the pre-intervention period。
With regard to the average cost of medication for emergency patients, the level iii hospitals reduced by 15. 95 per cent in the month of policy implementation and increased by 1. 05 per cent each month thereafter; level ii hospitals reduced by 6. 85 per cent in the month of policy implementation but did not translate into a long-term trend; and primary health-care institutions were not affected by the policy。
In terms of testing, san ming city has revised the cost of testing at different levels of health care to varying degrees, resulting in a reduction in the cost of testing for patients admitted to primary health care institutions and level ii hospitals. This change reflects not only the optimal structure of hospital income but also the positive impact of the price reform of medical services on the allocation of health resources, in line with the expected effects of the policy. There is a long-term trend towards increasing the cost of testing for patients in emergency care at primary health-care facilities, and it is recommended that attention and investment be increased at the grass-roots level to increase the capacity and efficiency of their services in order to bring more patients in emergency care closer to them and reduce the pressure on hospitals. The cost of testing was reduced in the month of the policy intervention for all patients in emergency care at level iii hospitals, but it did not translate into a long-term trend。
On the basis of the above, the share of income from health services in san ming city has continued to increase and the cost of hospital and emergency medical care has decreased or increased slowly, showing a positive trend。
Improving mechanisms and sustainable development
Further becoming the reform pole
The city of san ming has effectively curbed the rapid increase in the cost of medicine through a continuous mechanism of price adjustment for health services, increasing the income and share of health services and promoting the rational allocation of health resources. This is in line with the rules governing the pricing of health services and creates conditions for further reforms. There is a need to continue to refine the mechanisms in order to achieve sustainable development and to further become the hallmark of the reform of public hospitals。
For san ming municipality, there is a need to move from a price adjustment mechanism to a health-care-based compensation governance mechanism. One is the internal structure law. It is recommended that a reasonable proportion of health care, medicines, care, technology and management be established in the public hospital distribution system, with doctors earning 40 per cent, plus technicians, nursing and managers earning 60 per cent of the total, medicines, equipment and hardware costs sharing 40 per cent, and price discovery mechanisms for “physical costs + manualization” be established. The second is the multiplication of the external public sector. From the three dimensions of training costs, intensity of work and occupational risks, it is recommended that public hospital doctors ' income (annual salary) should be 1. 5 times the annual salary of public school teachers and more than twice the annual salary of public servants, reflecting the cost of training, occupational risks and social dignity of doctors。
At the national level, there is a need for planning, harmonization of financial standards, etc., to create conditions for the establishment of local mechanisms for the management of the income of doctors in public hospitals. One is to give top-level design and enactment of laws and regulations that support the internal structure of the doctors ' remuneration governance mechanism and the multiples of the external public sector. The second is to harmonize the financial profile of the financial integration of public hospitals and to promote the early introduction of full-cost management of public hospitals, on the basis of which a mechanism for regulating the distribution of hospital income will be established. If doctors of the same level of government hospitals in the same year earn less than teachers and civil servants, the reasons need to be found in terms of both the total income of the hospital and the distribution system. If the total income of the hospital is insufficient, there is a need to identify and improve the causes of the imbalance and to modernize the governance capacity of the government by looking at the population of the region, medical career planning, hospital positioning, the number of beds, the content of services, the cost of services and the payment of the financial budget and health insurance。
