Review on Pharmaceutical Pricing Reform of Urban Public Hospitals / 中国医院管理

Objective To describe and evaluate the strategies,status quo,effect and problems of pharmaceutical pricing reform in 4 batches of urban public hospitals in China.Methods Chinese database and website of Commission of Health and Family Planning were searched.Bibliometrics was done.Results A total of 33 studies were included by screening and reading the abstracts.Among them,4 were masters' theses,and 29 were research articles and reviews.Generally quantitative researches with strong study designs accounted for only a small proportion.Most of the local reforms achieved basic targets,such as cancelling medicine addition,increasing medical service price,improving hospital internal operating efficiency and controlling medical price,however problems still existed including incomplete adjustment for medical services prices and unmet needs of differentiated compensation plans.Conclusion The prices of medical services should make further adjustment.Efforts should still be made in terms of establishing dynamic compensation mechanism for urban public hospitals,coordinating the policy decision-making process for more integrated measurements including reforms on payment models and logistic process.

A comparison of ARIMA Model, BP Neural Network Model and combined model in health policy evaluation:An empirical study of public hospitals pricing reform / 中国卫生政策研究

Objective:To study the effectiveness of different time series models in the prediction of financial data in public hospitals,with the aim of obtaining a more reliable counterfactual in health policy evaluation. Methods:ARI-MA model,BP neural network and their combination were used for the estimation and prediction of drug revenue and medical service revenue based on a dataset for the period from November,2011 to October,2016 for hospital X before and after Nanjing medical pricing reform. Root mean square error (RMSE) was used to estimate the model accuracy. Results:RMSE of drug revenue from the three models were 692.82,501.44 and 380.80,and of medical service were 184.04,215.63 and 168.65. The findings shows that the combination model was proved to be the most efficient one a-mong the three. The combined model was used to calculate the net loss of drug revenue which was estimated to be 120, 440 million,and the net increase of medical service was estimated to be 185,326 million after the reform,which was 1. 539 times of the drug loss. Conclusions:The revenue data of public hospitals are usually complex with a both linear and non-linear trend. The combination model of ARIMA and BP neural network could solve the problem for once with an acceptable accuracy. However,ARIMA model is simpler to operate as compared to other two models, and also more consistent with the forecasting trend,therefore ARIMA is also recommended in the evaluation for health policies.

Effect evaluation of comprehensive reform of medical price in urban public hospital: A case study of Nanjing city / 中国卫生政策研究

Objectives:This study aims to analyze the change of income and medical service revenue of hospi-tals in Nanjing after the comprehensive reform of the medical prices of public hospitals,evaluate the effect of compen-sation and explore the differentiated compensation plan, and provide the basis for establishing the compensation mechanism of dynamic adjustment. Methods: A total of 10 municipal-affiliated hospitals were selected to collect fi-nancial income and expenditure data for the 48 months before the reform (2011.11—2015.10) and the 12 months after the reform(2015.11—2016.10) in Nanjing,and used interrupted time series model to estimate the growth rate of drug profit and service revenue,and finally made a comparison between the counterfactual and actual figures. Re-sults:It was found that,after the form,the drug profit decreased by 14.98%,and the service revenue increased by 24.79%. The revenue from medicines accounted for 42.7% and 36.9% before and after the reform respectively, and service for 28.9% and 30.3% respectively. The net financial aid accounted for 20.43% of the total drug-sales loss in average,and the net service revenue rate averaged 87.3% meeting the policy target,but within the 10 hospi-tals these rate ranged diversely from -21.9% to 712.5%,and 28.9% to 712.5%. The regression analysis indica-ted that the service compensation rate was significantly positively correlated with the proportion of service revenue in the total medical revenue before the reform. Conclusions:The Nanjing Pricing Reform basically achieved its desired goals of abolishing the drug-sales addition and the hospital compensation effect of 80% service +20% fiscal structure from service revenue and financial aid in average. However, the compensation differences among the hospitals are quite large with service-dependent hospitals compensated by over 400% and drug-dependent hospital less than 30%. However,for general hospitals,the compensation rated directly depended on the revenue structure before the reform and management performance and varied from 50% to 100%. The study at last gave its advices on improvement to further increase the service prices and establish a yearly-adjusted individualized compensation mechanism.

Discusion on the Calculation of Markov Model Transition Probability in Pharmacoeconomics Evaluation / 中国卫生经济

Markov model is one of the decision analysis models,which is widely applied in pharmacoeconomic evaluation.The acquisition of transition probability parameters among different Markov health states were difficult in model building and hard to be acquired directly.It discussed the calculation of current Markov model transition probability parameters,especially for the time-dependent model.Furthermore,it performed a case analysis to explore how to calculate the transition probability and provide references for researchers of related research.

Association between mannose-binding-lectin gene and type 2 diabetic patients in Chinese population living in the northern areas of China / 中华流行病学杂志

Objective To investigate whether the mannose-binding-lectin 2 (MBL2) gene was associated with type 2 diabetes in the populations living the northern part of China. Methods The study involved 318 type 2 diabetic patients and 448 normoglycemic controls. The variances of rs1800450, rs1800451 and rs11003125 were determined by the Multiplex SNaPshot method. Fasting blood-glucose, triglyceride and total cholesterol were also measured. All of these results were analyzed by logistic regression method. Linkage disequilibrium and Haplotype measures were computed in all samples using Haploview. Results There seemed no mutation on rs 1800451 while the rs 1800450 and rs11003125 polymorphism was consistent with Hardy-Weinberg expectations in both the case and the control groups. Genotypes and allele frequencies of rs1800450 as well as rs11003125 were observed (P=0.006, P=0.003) and (P=0.010, P=0.004), respectively. Data from logistic regression analysis revealed that factors as overweight, abdominal obesity, hypercholesterolemia, GG genotype frequencies of Exonl rs1800450 polymorphism as well as (GC + CC) genotype frequencies of rs11003125 polymorphism in MBL2 conferred increased risks for type 2 diabetes. Haplotype analyses of the two SNPs (rs1800450, rs11003125) revealed similar effects as compared with the single SNP associations. Only haplotype constructed from GC alleles conferred increased trends for type 2 diabetes (OR=2.21, 95％ CI: 1.47-3.33, P=0.000). Conclusion Our result suggested that the Exonl rs1800450 polymorphism and promoter region rs11003125 polymorphism in MBL2 gene were both associated with type 2 diabetes in the Chinese population living in the northern areas of China. The G allele of rs 1800450 and C allele of rs 11003125 might be the risk factors of type 2 diabetes.