Price Of Medical Services Research Articles

Research on the medical service pricing policy in China′s ongoing healthcare reform

Objective To analyze the medical service pricing policy of 30 provinces and autonomous regions in China and recommend on problems and challenges, for reference of medical service pricing reform in the future. Methods Literature review and policy analysis were used for summary and performance appraisal of medical service pricing of China. Results Most of the areas surveyed followed the step-by-step approach to gradually adjust pricing, while a few areas completed it in a one-time adjustment manner. 2015 witnessed most areas, up to 20 (66.67%), in price adjustment; their price adjustments focused on price reduction of large-scale medical equipment inspection fees and some medical tests. On the other hand, prices of diagnosis, nursing care, and treatment which are labor-intensive were increased. Conclusions Specifications of medical services are improving, yet there exist great gaps in the convergence of medical insurance. It is advisable to expedite the convergence of the new version specifications, to achieve value regression and dynamic price adjustment of medical services. Key words: Ongoing healthcare reform; Medical service; Price; Adjustment; Policy research

Can zero-markup policy for drug sales in public hospitals resolve the problem of ‘seeing a doctor is too expensive’ in China? A case study of four municipal general tertiary hospitals at H City in Z Province

The Chinese government launched its New Health System Reform in 2009 aimed at achieving the target of universal health coverage and resolving the long-standing problem of ‘seeing a doctor is too difficult and expensive.’ The Chinese government attributed the origin of this problem to the 15%-markup policy for drug sales in public hospitals from the mid-1990s and began the zero-markup reform as its main solution in 2013. Through a case study of four municipal general tertiary hospitals in H City in eastern China, we found that the zero-markup policy reduced the cost of patients’ drug spending and the income of hospitals’ drug sales, but did not reduce the average expense and out-of-pocket spending of patients. On the contrary, the average expense for medical inspection and examination is rising rapidly every year. Against the background of zero-markup reform for drug sales, public hospitals have gradually shifted from ‘feeding the hospital with drug sales’ to ‘feeding the hospital with medical inspection and examination’ by adding unnecessary services or overtreatments, having to find new ways to meet their costs. Some of this may represent supply-induced demand for services, replacing the supply-induced demand for drugs, which the former markup policy encouraged. We have also found that although the government adjusted the price of medical services to a degree when introducing the zero-markup reform of drug sales, the deficit in medical service funding has risen sharply in the public hospitals. This indicates that the medical service is priced significantly lower than actual costs of the service and that the related social insurance support is also inadequate, therefore continuing high levels of out-of-pocket costs are inevitable. To resolve the problem altogether, the Chinese government must promote a market-oriented reform of pricing mechanism of medical services and adjust the social insurance support accordingly. The key to New Health System Reform is to build a public negotiation mechanism between the government, social health insurance, representatives of hospitals/doctors, and citizens for medical service purchasing to determine the commonly accepted price of quality medical services and the amount patients should contribute themselves, through negotiation and compromise.

An analysis of competitive situation medical tourism industry: a case study in northwest Iran

Background: Medical tourism is a relatively new concept where patients travel to a foreign destination to obtain quality medical treatments which much better or comparable and also available at a significantly lower cost. Though, a number of literature available with regard to the tourism industry and the competitiveness of the destination for medical tourists are hardly focused specifically in Northwest Iran.Purpose: The aim of this study is to determine the competitive status of East Azerbaijan province medical tourism industry.Materials and Method: It was a qualitative study which conducted in-depth interviews with 15 key stakeholders of the tourism industry in East Azerbaijan Province (North-West of Iran). Purposive sampling technique was used and the data analyzed by using framework analysis based on Porter's diamond model.Results: In the factory conditions, there are 8 sub-themes such as political and ideological attitudes, similarities of language, culture, restrictions on communication skills, and tourist attractions. In the demand conditions, there is fame of the physicians and the waiting time for receiving medical treatment. In the strategy for structure and rivalry, 7 sub-themes are included such as lack of hospitals approved by JCI, affordability of medical and tourism service prices, inefficient advertising system, and the strengthening medical tourism infrastructure in neighboring countries. Others regarding with supporting industries are poor tourism infrastructure, inadequate support of private sector, poor transfer of medical tourists, and Visa facilitation services.Conclusion: Long-term planning and involvement of private sector in strengthening the tourism infrastructure should be put at agenda in terms of making province’s medical tourism policy.

How is public health service performance related to institutional arrangements in OECD countries?

This study compares the institutional arrangements and performance of the public health services in 30 OECD countries using a fuzzy-set ideal-type analysis and Fs/QCA. Three dimensions of the institutional arrangements have been selected to empirically classify the public health service systems: (1) the ways in which financial resources are created, (2) the extent to which consumers can choose service providers, and (3) the extent to which the government regulates public health service providers in terms of service price, operational procedures, and facilities. The fuzzy-set ideal-type analysis results in eight categories of public health service systems on the basis of their institutional arrangements. This fuzzy-set ideal typology is richer in detail to characterize institutional arrangements for public health services, while at the same time largely embracing the existing theoretical categorizations of the public health service systems of the OECD countries. The Fs/QCA has identified conjunctural sufficient conditions to explain the performance of the public health service systems. Hence, the results of the analysis provide several policy implications. For example, there can be multiple paths to longer life expectancy in higher income countries. One such path is to have national health insurance while allowing more choices for health service providers. Another path is to effectively regulate the prices of medicine and medical services, while not intervening in health insurance and service provider issues.

Discussions on the " Tripartite-sector reform" , a model empowered by medical insurance: Sanming as a focal

Tripartite-sector reform (a synergistic reform in public health services, medical insurance and medicine production-circulation) in Sanming city was described in the paper which centers on medical insurance. Tapping full potentials of the medical insurance, the city achieved efficient synergy among healthcare, medical insurance and medication systems. This reform has trimmed out inflated drug pricing to some extent for rooms of maneuver of medical service pricing changes, thus curbing excessive growth of medical costs successfully. The authors proposed areas of further improvements including the relationship between achieving such objective as curbing medical expenditure, and advancement of technical/medical service capacity; that between integrative control of medical insurance expenditure and protection of people's health; the equilibrium of interests between medical insurance, healthcare and medication. All these will contribute to the goal of healthy patients flow and a hierarchical medical system. Key words: Sanming; Medical insurance function; Tripartite-sector reform; People's health

Research on public hospital franchise

This thesis introduced the concept and the present franchise practice at China′s hospitals, and analyzed problems found in such a franchise.In view of these challenges, the authors proposed such measures as establishing scientific and efficient public hospital franchise development programs in terms of better laws and regulations, management system and service models.Other policy suggestions raised cover income distribution, medical service pricing and social security designation qualification. Key words: Public hospital; Franchise; System reform

Comparative study of medical service pricing of Beijing with those of others provinces

Objective To analyze the present situation of medical service prices in Beijing, and provide scientific basis in order to carry out the reform of medical service prices of the city. Methods Literature review method to collate the administration policy of medical service price in Beijing, and the method of statistical analysis to compare the Beijing medical service prices with 19 other provinces across the country. Results The number of medical service projects (4 613) in Beijing is higher than the national average (4 507), but the average medical service prices (423 yuan) in Beijing is lower than the national average (609 yuan), and medical service price and the regional economic level has no statistical significance Conclusion Medical service prices of Beijing need to be adjusted, and a reform of medical service prices in Beijing should be implemented by the Development and Reform Commission, Health and Family Planning Commission. Key words: Beijing; Medical services price; Comparison

Association of Hospital Prices for Coronary Artery Bypass Grafting With Hospital Quality and Reimbursement

Although prices for medical services are known to vary markedly between hospitals, it remains unknown whether variation in hospital prices is explained by differences in hospital quality or reimbursement from major insurers. We obtained "out-of-pocket" price estimates for coronary artery bypass grafting (CABG) from a random sample of US hospitals for a hypothetical patient without medical insurance. We compared hospital CABG price to (1) "fair price" estimate from Healthcare Bluebook data using each hospital's zip code and (2) Society of Thoracic Surgeons composite CABG quality score and risk-adjusted mortality rate. Of 101 study hospitals, 53 (52.5%) were able to provide a complete price estimate for CABG. The mean price for CABG was $151,271 and ranged from $44,824 to $448,038. Except for geographic census region, which was weakly associated with price, hospital CABG price was not associated with other structural characteristics or CABG volume (p >0.10 for all). Likewise, there was no association between a hospital's price for CABG with average reimbursement from major insurers within the same zip code (ρ = 0.07, p value = 0.6), Society of Thoracic Surgeoncomposite quality score (ρ = 0.08, p value = 0.71), or risk-adjusted CABG mortality (ρ = -0.03 p value = 0.89). In conclusion, the price of CABG varied more than 10-fold across US hospitals. There was no correlation between price information obtained from hospitals and the average reimbursement from major insurers in the same market. We also found no evidence to suggest that hospitals that charge higher prices provide better quality of care.

Impact of China's Public Hospital Reform on Healthcare Expenditures and Utilization: A Case Study in ZJ Province.

BackgroundHigh drug costs due to supplier-induced demand (SID) obstruct healthcare accessibility in China. Drug prescriptions can generate markup-related profits, and the low prices of other medical services can lead to labor-force underestimations; therefore, physicians are keen to prescribe drugs rather than services. Thus, in China, a public hospital reform has been instituted to cancel markups and increase service prices.MethodsA retrospective pre/post-reform study was conducted in ZJ province to assess the impact of the reform on healthcare expenditures and utilization, ultimately to inform policy development and decision-making. The main indicators are healthcare expenditures and utilization.ResultsPost-reform, drug expenditures per visit decreased by 8.2% and 15.36% in outpatient and inpatient care, respectively; service expenditures per visit increased by 23.03% and 27.69% in outpatient and inpatient care, respectively. Drug utilization per visit increased by 5.58% in outpatient care and underwent no significant change in inpatient care. Both were lower than the theoretical drug-utilization level, which may move along the demand curve because of patient-initiated demand (PID); this indicates that SID-promoted drug utilization may decrease. Finally, service utilization per visit increased by 6% in outpatient care and by 13.10% in inpatient care; both were higher than the theoretical level moving along the demand curve, and this indicates that SID-promoted service utilization may increase.ConclusionThe reform reduces drug-prescription profits by eliminating drug markups; additionally, it compensates for service costs by increasing service prices. Post-reform, the SID of drug prescriptions decreased, which may reduce drug-resource waste. The SID of services increased, with potentially positive and negative effects: accessibility to services may be promoted when physicians provide more services, but the risk of resource waste may also increase. This warrants further research. It is recommended that comprehensive measures that control SID and promote physician enthusiasm be carried out concurrently.

Dynamic Model and Simulation of Medical Service Pricing

Dynamic Model and Simulation of Medical Service Pricing

Development of price comparison method system for Shanghai's medical service pricing

The paper reviewed the medical service pricing at home and abroad and progress in the price comparison system, and introduced the price comparison system of Shanghai's medical services. Proposals in the paper include building the price parameters fitting local conditions, and setting prices using the standardized price model; forming a comprehensive price adjustment scheme with reference to international price comparison relations and domestic pricing level; upgrading the fine pricing management level of medical service pricing and improving charging management dimensions; enhancing interactions and assessment of price-related departments to guide public hospitals to enhance Key words: Medical service; Price; Price comparison system; Methods

A moral price for medicine.

In his seminal text ‘The Gift Relationship’, Richard Titmuss famously contrasted voluntary and commercial systems of blood donation.(1) His conclusion that an altruistic system was superior immediately drew criticism from famed economist Kenneth Arrow, who argued that a commercial system provided more choice since hospitals and patients can choose from both commercial and voluntary sources, noting flaws in Titmuss’ epistemology and methodology.(2) Even philosopher Peter Singer, in a defence of Titmuss, acknowledged the role of a pricing system in alleviating an acute shortage of blood in Korea.(3) Medical services are more complex than blood donation. Hence, determining a fair price is a practice that has been fraught with controversy. India fined the drug company Novartis for allegedly overcharging for its painkiller Voveran.(4) Singapore’s medical statutory board fined and suspended surgeon Susan Lim for overcharging the Bruneian royalty.(5) The case was highly controversial as the Singapore Medical Council determined that there was an unstated ‘ethical limit’ to the prices of medical services(6), to the chagrin of some who viewed this limit as amorphous and arbitrary. This paper seeks to explore the pros and cons of the free market in regulating healthcare pricing and discuss whether there can be a fair and ethical price for medicine.

Comment on “How does the Price Regulation Policy Impact on Patient–Nurse Ratios and the Length of Hospital Stays in Japanese Hospitals?”

It has been said that the fee-for-service (FFS) system in Japan's public health insurance system is a major contributor to Japan's relatively low national medical expenditures. Basically, this system allows the central government to almost fully control the prices of medical services through the reimbursement system of public health insurance, which covers most of the medical usage in Japan. This price control has been used for not only suppressing total medical expenditures, but also for balancing the allocations of medical resources by making higher rewards for services in short supply. Noguchi (2015), however, reveals the limitations of this approach by showing the “overreaction” of patient–nurse ratio (PNR) to changes in the FFS criteria. I have four major comments on Noguchi's (2015) paper. First, I would have liked to have seen a more detailed description about the reasons why the government wanted to lower PNR at the particular times it did. In particular, since the abstract and conclusion read as if the main policy implication of Noguchi (2015) is that the changes in the FFS caused an undesired outcome (an increase in beds for acute care), Noguchi should explain why the government, which wanted to reallocate health-care resources toward subacute and long-term care, also aimed to lower the PNR at the same time. As mentioned in Noguchi's paper, the changes in FFS intended to lower PNR and shorten the length of hospital stays (LHS), and the empirical results suggest that both PNR and LHS actually decreased in response to the changes. That is, the revision achieved its primary objectives. If the final goal of this fee revision is to expedite the treatment of acute diseases through the provision of more intensive human resources, I feel it is off the point to accuse hospitals of inducing more resources toward acute care. A second and related comment relates to the overall goals of the series of FFS revisions in Japan. In the concluding section, Noguchi argues that “[a] series of revisions of FSS aim to clarify and differentiate the roles and functions of medical facilities with various characteristics” (p. 318), and this argument seems to be the basis for the rather negative tone of Noguchi's overall evaluation of the FFS revision in 2000 and 2006. However, non-experts (like me) cannot see how the government actually planned to achieve such a differentiation by the FFS revisions. Were there any revisions other than the ones examined in this paper to focus on the differentiation, or were the policymakers just saying that the roles and functions of medical facilities should be differentiated? If the latter is the case, I think the problem is more on the self-inconsistency of the policy rather than the overreaction of the hospitals. Third, to me it was not very clear why the effect of the revisions on LHS is larger for small hospitals, whereas the effect on PNR is small and statistically insignificant for them. It is not surprising that small hospitals cannot recruit as many nurses as they want, and thus they cannot lower PNR as much as larger hospitals. Then, however, the effect on LHS should be smaller for them if the FFS revision affects LHS through a lower PNR. Even if the FFS revision has a direct effect on LHS through the price change, unless it differentiates hospitals by its size, it is not clear why small hospitals respond more. Fourth, it would be very informative if Noguchi provided further evidence on the heterogeneous effects across different types of hospitals other than those related to hospital size. For example, hospitals in underpopulated area may have difficulties in recruiting nurses because they are less attractive workplace for nurses and are more financially stressed than other types of hospitals. If so, the effects on PNR should be smaller for such hospitals. Also, the ownership of hospitals may affect hospital compliance. I believe such information should be available from the data used in this study, so it could be a good extension for future research.

Application of the Activity-Based Costing Method for Unit-Cost Calculation in a Hospital.

Background:Choosing an appropriate accounting system for hospital has always been a challenge for hospital managers. Traditional cost system (TCS) causes cost distortions in hospital. Activity-based costing (ABC) method is a new and more effective cost system.Objective:This study aimed to compare ABC with TCS method in calculating the unit cost of medical services and to assess its applicability in Kashani Hospital, Shahrekord City, Iran.Methods:This cross-sectional study was performed on accounting data of Kashani Hospital in 2013. Data on accounting reports of 2012 and other relevant sources at the end of 2012 were included. To apply ABC method, the hospital was divided into several cost centers and five cost categories were defined: wage, equipment, space, material, and overhead costs. Then activity centers were defined. ABC method was performed into two phases. First, the total costs of cost centers were assigned to activities by using related cost factors. Then the costs of activities were divided to cost objects by using cost drivers. After determining the cost of objects, the cost price of medical services was calculated and compared with those obtained from TCS.Results:The Kashani Hospital had 81 physicians, 306 nurses, and 328 beds with the mean occupancy rate of 67.4% during 2012. Unit cost of medical services, cost price of occupancy bed per day, and cost per outpatient service were calculated. The total unit costs by ABC and TCS were respectively 187.95 and 137.70 USD, showing 50.34 USD more unit cost by ABC method. ABC method represented more accurate information on the major cost components.Conclusion:By utilizing ABC, hospital managers have a valuable accounting system that provides a true insight into the organizational costs of their department.

Abstract 208: Association of Hospital Prices for Coronary Artery Bypass Graft Surgery with Hospital Quality and Reimbursement

Background: Although prices for medical services are known to vary markedly between hospitals especially for patients without medical insurance, it remains unknown whether this large variation in price is explained by differences in hospital quality or reimbursement from major insurers. Methods: We obtained an “out-of-pocket” hospital and physician price estimate for a coronary artery bypass graft (CABG) surgery for a hypothetical patient without medical insurance via telephone call from a random sample of U.S. hospitals during January 2014. We examined whether the price provided by a hospital was associated with its 1) structural characteristics obtained from the American Hospital Association data, 2010 2) risk-standardized CABG mortality obtained from the Society of Thoracic Surgeons data, 2013 and 3) “fair price” estimate for CABG base don reimbursement data from major insurers in the zip code of the hospital location (Healthcare Bluebook, www.healthcarebluebook.com). Results: We contacted a total of 111 U.S. hospitals, of which 56 (50.5%) were able to provide a price estimate for CABG. The mean price for CABG obtained from the hospitals was $151,784.64, and ranged from $44,824 - $448,039. Except geographic location (p=0.03), which was weakly associated, hospital prices for a CABG surgery were not associated with teaching status, for-profit/not-for-profit/government classification, urban/rural location, or CABG volume (p >0.10 for all). Likewise, we found no association between a hospital’s quoted price for CABG and its risk-standardized CABG mortality (r= -0.03 p=0.89), or its average reimbursement for CABG surgery from major insurers within the same zip code (r= 0.07, p=0.6). Conclusion: We found a 10-fold variation in the prices obtained from U.S. hospitals for CABG surgery for an uninsured patient. Although there was slight variation in CABG surgery prices based on geographic region, we found no evidence to suggest that hospitals with higher prices have lower mortality or receive higher reimbursement from insured patients.

Pharmacoeconomic analysis of the use of first- and second-line drugs in the treatment of multiple sclerosis

Objective: to make a pharmacoeconomic comparison of the administration of first- and second-line drugs in the treatment of multiple sclerosis through cost, cost-effectiveness, and budget impact analyses using the 2015 state prices. Material and methods. A pharmacoeconomic analysis was carried out on the basis of the data available in the literature on trials of the effects of the drugs on the rates of exacerbations and disability. On calculating, the authors took into account the current standards for the out- and inpatient management of patients with this nosological entity in accordance with the compulsory health insurance (CHI) program; prices for state drug purchases in March 2015; prices for medical services in compliance with the CHI standards in Moscow in 2015; the average sizes of minimum wage, salary, and disability grants with consideration for a discount rate of 3%. The cost-effectiveness and budget impact analyses were performed for intramuscular interferon (INF)-β1a (avonex, 30 μg), subcutaneous INF-β1a (rebif, 44 μg), subcutaneous INF-β1b (ronbetal, 8,000,000 IU), subcutaneous INF-β1b (betaferon, 9,600,000 IU), subcutaneous glatiramer acetate (copaxone, 20 mg), intravenous natalizumab (tyzabri, 300 mg), and oral fingolimod (gilenya, 0.5 mg). Results and discussion. The second-line drug tyzabri outperforms the first-line agents for cost-effectiveness. The first-line drugs betaferon and copaxone is slightly exceeded in this indicator by tyzabri; the other both first- and second-line agents compared are all the more inferior in this indicator. The budget impact analysis has shown that the cost of the second-line drugs was higher than that of the first-line ones.

How much should cost a medical consultation? A marketing analysis from the viewpoint of health sector in Brazil

The health sector has undergone profound changes regarding their business model. Today there are strong pressures for lower prices, which resulted from an increasingly competitive market that seeks to optimize resources. The service provided by a medical professional has undergone major transformations, supported in the past by social, ethical values, quality of care, humanization and optimization of labor, and quality of life, and are recently turned into a mercantilist model focused on the production scale, mass care, and profit. This article discusses about the variables that influence the pricing of medical services and the various issues involved in quality and perceived value of these services by the customer. This knowledge is extremely useful to help medical professionals in formatting price in its different services.

Research on the Pricing Model of Medical Services in China Based on System Dynamics Method

The current medical charge system is dominated by the government. Facts have proved that this system had caused many unreasonable phenomena. Consequently, the reform of medical service pricing system is emphasis and difficulty in China’s medical system reform. The paper sets up the pricing process of medical services to analyze the dynamic mapping relationships between various factors. And this paper breaks the government independent pricing mold and establishes the medical service pricing method of government and hospitals co-decision. Furthermore, this paper applies System Dynamics method to build the simulation model of pricing medical services on Vensim simulation platform that can overcome many drawbacks existing in the current pricing system of China’s public hospitals. In addition, this paper compares simulation results with the current price of Abdominal Vascular Color Doppler Ultrasound to illustrate the advantages of this model. The study will be helpful for the reform on new health care system in China.

Access by Patients to Healthcare Prices Results in Lower Expenditures

Health economists believe that patients would make better healthcare decisions if they had access to the actual price of medical services. In

运用品管圈改进医疗服务计费工作质量

Objective: To investigate the application of QCC management tools in improving the work quality of medical service pricing. Methods： To retrospectively analyze the effect of quality control circle on the work quality of medical service pricing. Results: Using the QCC circle management tool, can charge and accurately to guide clinical price project link, reduce the error rate, guarantee both doctors and win-win. Conclusions: QCC management tool, can improve the accuracy of the medical fees prices, transparency, is advantageous to the hospital economic operations and the interest of the patient, is today's medical institutions to adapt to the market economy and an effective regulatory tool.