Calculation and analysis of the total pricing adjustment of medical services based on medical costs

Abstract

The medical costs of public hospitals were divided into four categories of manpower cost, healthcare material cost, drug cost and other cost based on the business operating data of 2013 in Shanghai for calculation categories respectively, with analysis of their compensation channels as well. The calculation found that in the present financial subsidy pattern without drug price markup, the pricing adjustment of medical services in Shanghai was 7.50 billion to 11.69 billion yuan, which is necessary to maintain public hospitals as economically sustainable. Per-visit price of outpatient and emergency service should increase 10.6 to 27.7 yuan, average inpatient expense per bed day should increase 76.7 to 151.4 yuan, and medical insurance expenditure should increase 1.51 billion to 3.33 billion yuan, accounting for 7.3% to 16.1% of the accumulated surplus of medical insurance fund of Shanghai in 2013. Based on the above, the paper recommended to set the total pricing adjustment of medical prices on a rational basis, in consideration of the business operation of public hospitals, affordability of medical insurance fund, and overall burden of the people, in line with such measures as lowering drug and consumable costs, regulating medical behavior, and encouraging medical institutions to engage in cost accounting. Key words: Medical service; Pricing; Adjustment; Government financial subsidy; Calculation