15 April 2024, Volume 38 Issue 4
    

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  • Comprehensive evaluation of the effect of DRG reform in Sanming public hospitals based on interrupted time series analysis
    LI Jidi, LI Min, GONG Chunbo
    Soft Science of Health. 2024, 38(4): 1-5. https://doi.org/10.3969/j.issn.1003-2800.2024.04.001
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    Objective To analyze the impact of C-DRG and CN-DRG payment reform in Sanming city on medical income, service efficiency and patient burden in secondary and tertiary public hospitals. Methods By using the methods of interrupted time series, grey correlation degree and structural variation, the pharmaceutical income and other indicators of 22 public hospitals from 2015 to 2019 were retrospectively analyzed. Results After the implementation of DRG payment reform in Sanming city, the medical income of secondary hospitals decreased by 5.2%, and it had no significant impact on the medical income of tertiary hospitals. The average length of stay and the utilization rate of beds in secondary and tertiary hospitals had no significant change. The average cost of outpatient and emergency per visit in tertiary hospitals increased by 2%, and the average cost of discharged cases was not significantly affected. The average cost of discharges at secondary hospitals increased by 8.4% after a decrease of 10.8%. Conclusions Under the DRG reform in Sanming city, the situation of public hospitals is stable and improving. DRG can improve the clinical pathway and promote the cost control of medical institutions. In the future process of medical reform, the characteristics of different levels of hospitals should be further considered, and the supervision and management of the reform should be strengthened.
  • An empirical study on the implementation effect of DRG point payment—based on interrupted time series model
    JI Men, HUANG Xiuqin, KONG Xuhui, ZHOU Jiehua, ZHU Rong
    Soft Science of Health. 2024, 38(4): 6-10. https://doi.org/10.3969/j.issn.1003-2800.2024.04.002
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    Objective To evaluate the effect of DRG point payment, and to provide the reference for hospital management and policy improvement. Methods The inpatients with medical insurance in a tertiary hospital in Taizhou city from 2017 to 2023 were research objects. The effects of DRG point payment on operational efficiency, medical cost, medical burden and medical insurance expenditure were analyzed by descriptive analysis, chi-square test and interrupted time series analysis. Results After the implementation of DRG, the average length of stay, the average hospitalization expenses, the average drug expenses, and the average out-of-pocket expenses showed a downward trend (P values were all less than 0.05). The average costs of laboratory examination, check-up and medical services showed an upward trend (P values were all less than 0.05). There was no statistically significant in differences of trend change of monthly discharges, average consumables cost and average pooling fund expenditure (P values were all greater than 0.05). Conclusions DRG implementation has played a positive role in improving operational efficiency, reducing average hospitalization costs, optimizing cost structure, and reducing the burden of medical treatment, but it has little impact on the volume of hospital services and expenditure of medical insurance fund.
  • Analysis of influencing factors of high rate cases under DRGs payment—a case study of the psychiatric group
    LIU Zhidong, HE Ruirui
    Soft Science of Health. 2024, 38(4): 11-14. https://doi.org/10.3969/j.issn.1003-2800.2024.04.003
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    Objective To analyze the factors influencing the high rate of hospitalized cases in psychiatry. Methods A statistical analysis was made on the high rate patients discharged from a psychiatric hospital from January to December in 2022 reflected through the CHS-DRG(1.1)grouping device, and experts were organized to discuss the problem cases. Results There were 229 high rate cases among the 12382 psychiatric cases in 2022. There were 49 cases (21.40%) in unclassified electroshock MECT, 11 cases (4.80%) of adolescent multi-tool treatment, six cases (2.62%) in elderly patients with severe complications and comorbidities, 64 cases (27.95%) with more than 60 days of length of stay, 15 cases (6.55%) of combined treatment for comorbidities, 82 cases (35.81%) with unreasonable grouping scheme, and two cases (0.87%) of grouping errors caused by coding. Conclusions The main influencing factors of the high rate of psychiatric cases are: source distortion in calculation, unreflected psychiatric comorbidities, large deficits in MECT group, significant differences in the difficulty of treating mental disorders in children and adolescents compared with adults, unreasonable grouping of some disease groups, coding quality and etc.
  • Research on the development trend of China's essential drug system in the new era
    ZHANG Haitao
    Soft Science of Health. 2024, 38(4): 15-18. https://doi.org/10.3969/j.issn.1003-2800.2024.04.004
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    As a breakthrough in the reform of China's medical and health system at the present stage, the essential drug system has problems of shortage of drug supply and structural imbalance in the field of drug supply, and problems of drug safety and drug misuse in the field of drug use. The main reasons include the imperfect legal system of essential drug system, the imperfect monitoring and incentive mechanism, the inadequate implementation of quality management mechanism and the lag of doctor-patient main body. It is suggested to further improve the legal construction of essential drug system, effectively improve and implement the relevant monitoring and incentive mechanisms for enterprises and medical institutions, further promote the consistency evaluation of essential drugs, and build a long-term mechanism for the rational use of drugs, so as to promote the further development and improvement of the essential drug system.
  • Research on medical risks sharing mechanism based on social standard
    ZHANG Xia, LIU Shaofei
    Soft Science of Health. 2024, 38(4): 19-23. https://doi.org/10.3969/j.issn.1003-2800.2024.04.005
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    The limitation of medical technology, the complexity of medical activities and other factors make it difficult to avoid medical risks and easy to produce doctor-patient conflicts. Under the dilemma between the protection of patients' rights and hospital cost control, the rights and interests of both doctors and patients are difficult to balance. By analyzing the current situation and necessity of the system of medical risks shared by social forces, it is proposed that doctor-patient conflicts can be effectively resolved and a good medical treatment order can be maintained by facilitating information exchange and communication between doctors and patients, improving supervision, forming comprehensive insurance with complementary functions, and strengthening the settlement of doctor-patient conflicts through the third party.
  • Research on problems and countermeasures of standards for long-term care insurance
    LIU Jingkun
    Soft Science of Health. 2024, 38(4): 24-28. https://doi.org/10.3969/j.issn.1003-2800.2024.04.006
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    Since China launched the pilots of long-term care insurance system in 2016, some areas have actively carried out pilot exploration and achieved initial results. However, at present, there are still problems such as the lack of mandatory national standards for disability assessment, unclear long-term criteria, lack of standards for the qualification of practitioners, lack of regulations for appointed supervision of institutions, lack of uniform standards for service quality, and unclear reimbursement standards.Specific suggestions are put forward according to above problems to provide the reference for the development and improvement of China's long-term care insurance system.
  • Research on the cooperation strategy of Internet plus hierarchical diagnosis and treatment based on telemedicine
    LIU Haopeng, MA Chengyu
    Soft Science of Health. 2024, 38(4): 29-33. https://doi.org/10.3969/j.issn.1003-2800.2024.04.007
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    Objective This paper probes into the benefit distribution and promotion strategies of Internet plus hierarchical diagnosis and treatment based on telemedicine, and provides the reference for reasonable pricing and effective operation of telemedicine in China. Methods After the Internet plus hierarchical diagnosis and treatment system was abstracted, a game model of community hospitals and large hospitals was constructed, and the equilibrium solution was carried out. Results The two sides were more likely to cooperate when the price of telemedicine and offline medical treatment was relative higher. However, when there was a large gap in the proportion of profit distribution between the two sides, the two sides were more likely to give up cooperation. When community hospitals paid more attention to patients' health, the utilization rate of telemedicine was higher, and the probability of cooperation was greater in mixed strategy equilibrium. Conclusions Internet plus hierarchical diagnosis and treatment based on telemedicine has the potential to be popularized. It is suggested to appropriately raise the pricing of telemedicine, balance benefit distribution in two levels of hospitals, and provide supervision and guidance in the cooperation process.
  • Influence of perceived social support on the subjective well-being of elderly floating population
    SUN Zhonggen, DU Ke
    Soft Science of Health. 2024, 38(4): 34-37. https://doi.org/10.3969/j.issn.1003-2800.2024.04.008
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    Objective To explore the influence of perceived social support on the subjective well-being of elderly floating population, and to provide a basis for improving the subjective well-being of elderly floating population. Methods Based on the theory of social support, questionnaire survey and quantitative analysis were used to explore the relationship between perceived social support, self-efficacy and subjective well-being of the elderly floating population over 60 years old in Nanjing. Results Perceived social support (r=0.499, P<0.05) and self-efficacy (r=0.404, P<0.05) were positively correlated with subjective well-being, and perceived social support was positively correlated with self-efficacy (r=0.363, P<0.05). Conclusions Self-efficacy plays a partial mediating role in perceived social support and subjective well-being of the elderly floating population. The three dimensions of perceived social support (family support, friend support and other support) have different effects on the subjective well-being of the elderly floating population. Efforts should be made to improve their subjective well-being.
  • Study on the demand and influencing factors of the integrated medical and elderly care services for empty nesters in the community
    WANG Xuaner,LI Dehua,MAI Chenyao,HAO Yuxi,HU Jun
    Soft Science of Health. 2024, 38(4): 38-44. https://doi.org/10.3969/j.issn.1003-2800.2024.04.009
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    Objective To analyze the current status and influencing factors of integrated medical and elderly care services for empty nesters in the community, and to provide the reference for optimizing integrated medical and elderly care services in the community and improving the health level of empty nesters. Methods Based on the data of 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS), the study described the demand of empty nesters and supply of integrated medical and elderly care services in the community. The main influencing factors of the demand of integrated medical and elderly care services in the community for empty nesters were explored by using chi-square test and binary logistic regression. Results A total of 4087 empty nesters were included in the study. The proportion of demand and supply of seven integrated medical and elderly care services in the community were as follows: living care services (64.9%, 9.1%), daily shopping services (62.2%, 11.2%), social and entertainment services (69.3%, 24.5%), housecalls and medicine delivery services (81.2%, 34.6%), healthcare education services (75.7%, 45.0%), psychological counseling services (68.3%, 14.0%), and legal aid services (66.9%, 23.4%). Age, total household income last year, possession of medical insurance, possession of pension insurance, and the number of children were important influencing factors of the demand for integrated medical and elderly care services in the community among empty nesters (P<0.05) . Conclusions The supply of integrated medical and elderly care services in the community can not meet the demand of empty nesters. Measures should be taken to accelerate the construction of a high-quality social security system for the elderly, focus on key empty nesters, and provide targeted integrated medical and elderly care services to improve the integrated medical and elderly care services in the community.
  • Research on influencing factors of the effective implementation of the “Hong Kong and Macao Medicine and Equipment Connect” policy based on the Smith Model
    HE Shujin, LONG Haixia, HUANG Yue
    Soft Science of Health. 2024, 38(4): 45-47. https://doi.org/10.3969/j.issn.1003-2800.2024.04.010
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    Based on the orientation and implementation effectiveness of the “Hong Kong and Macao Medicine and Equipment Connect” policy in the Guangdong-Hong Kong-Macao Greater Bay Area, this paper uses Smith's policy implementation process model to study and analyze the implementation process of the “Hong Kong and Macao Medicine and Equipment Connect” policy from four aspects: idealized policies, implementing agencies, target groups and environment of policy implementation. It is concluded that the policy has some problems, such as the limitation of the policy, the lack of ability of the executive agencies, the low willingness of the target groups, and unfavorable policy environment for development. Suggestions are put forward in the follow-up optimized policy to improve supporting policies, consolidate the responsibilities of various subjects, enhance the level of information technology, and strengthen research in real world, so as to ensure the safety and effective control of medicine and equipment in Hong Kong and Macao, promote the sustainable development of the “Hong Kong and Macao Medicine and Equipment Connect” policy, and help the construction of Healthy Greater Bay Area.
  • Discussion on the classification and pricing mechanism of complex medical services based on value-based healthcare
    ZHANG Zijun, WANG Jieliu, XIANG Qian
    Soft Science of Health. 2024, 38(4): 48-51. https://doi.org/10.3969/j.issn.1003-2800.2024.04.011
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    Based on the concept of value-based healthcare (VBHC) and relevant policies for the classification of medical services, this article summarizes and refines the characteristics of complex medical services, and analyzes the factors affecting complex medical services so as to preliminarily determine the classification of complex medical services and discuss the medical pricing mechanism. On the basis of current classification of medical prices and related research, this paper puts forward some suggestions and prospects for the reform of the value-based medical pricing mechanism.
  • Practice and exploration of comprehensive trusteeship model of newly built district hospitals under the background of the integrated health community—take the trusteeship model of Jiangqiao Hospital in Jiading District of Shanghai as an example
    WANG Junyan, ZHENG Yaqun, WAN Zhiqiang
    Soft Science of Health. 2024, 38(4): 52-55. https://doi.org/10.3969/j.issn.1003-2800.2024.04.012
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    Hospital trusteeship is one of the important measures to promote the high-quality medical resources at the grassroots level and the construction of hierarchical diagnosis and treatment system under the new situation. Taking the trusteeship model of Jiangqiao Hospital in Jiading District of Shanghai as an example, the practical experience and initial results of trusteeship principles and objectives, personnel deployment, management and decision-making mechanism and information construction are summarized. The enlightenments are as follows: early intervention in the preparation stage is beneficial to the planning and trusteeship of the overall hospital layout; under the business alliance of integrated health community, comprehensive trusteeship is more conducive to the integration of medical resources; the top-level design of information technology is the key to the success of close-type medical alliance. Suggestions: the functional positioning of regional medical centers should be considered ahead; organizational integration and collaboration promote homogenization of hospital management and medical services; the dilemma of staff, funds and properties should be bridged in order to pave the way for the comprehensive trusteeship model of the newly built district hospitals in the background of the integrated health community.
  • Research on the equity of health human resource allocation in Shandong Province based on the agglomeration degree
    SUI Shujuan, ZHANG Quan, WU Haibo
    Soft Science of Health. 2024, 38(4): 56-61. https://doi.org/10.3969/j.issn.1003-2800.2024.04.013
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    Objective To analyze the equity and change trend of health human resource allocation in 16 prefecture-level cities in Shandong Province from 2016 to 2021, and to provide the reference for the government to further optimize resource allocation. Methods The number of personnel in health institutions, health technicians, practicing (assistant) physicians and registered nurses in 16 prefecture-level cities in Shandong Province from 2016 to 2021 was selected as indicators, and the agglomeration degree was used to calculate the agglomeration level of health human resources. The relative equity of health human resources allocation in Shandong Province in the past six years was analyzed from the dimensions of year, region and population. Results From 2016 to 2021, the trend of health human resources allocation in eastern, central and western regions of Shandong Province was basically the same, and the western region showed an overall upward trend. The HRAD of all types of health human resources in the eastern region was greater than 1, indicating that the equity of geographical allocation was better. The difference of HRAD-PAD between health technicians and practicing assistant physicians in western China was less than 0, indicating that the equity of allocation by population was poor. Conclusions From 2016 to 2021, there are significant differences in the equity of regional health human resources allocation in Shandong Province, but it is constantly optimized. In order to promote the equity of the health human resources allocation in Shandong Province, it is necessary to formulate policies taking into account multiple factors while rationally allocating resources, improve the policies of “cultivation, introduction, retention and employment”, advocate the development philosophy of “regional coordination”, so that the health service system can provide fair and effective health services to residents.
  • Prediction and analysis of the scale of practicing (assistant) physicians in China based on multiple prediction models
    DING Hao, FENG Jing, ZHAI Tiemin, LI Yan, WAN Quan
    Soft Science of Health. 2024, 38(4): 62-65. https://doi.org/10.3969/j.issn.1003-2800.2024.04.014
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    Objective To predict the change trend of the scale of practicing (assistant) physicians from 2023 to 2030, and provide the reference and suggestions for government departments to optimize the allocation of practicing (assistant) physicians. Methods By combining the grey model, manpower / population ratio, and health service demand, the scale of practicing (assistant) physicians from 2023 to 2030 is predicted according to different weights. Results From 2023 to 2030, the number of practicing (assistant) physicians in China will gradually increase, and the number of practicing (assistant) physicians per thousand population will increase from 4.16 in 2023 to 4.37 in 2025 and 4.88 in 2030. Conclusions The unequal weight combination model is practical and feasible. The total number of practicing (assistant) physicians in China will continue to grow, but it has not yet met the needs of residents for medical and health services.
  • Analysis of the quality of mental health services in medical institutions in Guangxi
    HUANG Wenhua, CHEN Qiang, ZHU Pinghua, CUI Peng, ZOU Zhenyou, MA Ajun, ZHU Jiezhou, YE Fanpei
    Soft Science of Health. 2024, 38(4): 66-70. https://doi.org/10.3969/j.issn.1003-2800.2024.04.015
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    Objective To research and evaluate the quality of mental health services in medical and healthcare institutions in Guangxi. Methods A total of 68 medical and healthcare institutions were selected from 14 cities with districts in Guangxi to evaluate the quality of mental health services from the aspects of basic conditions, medical quality and safety, nursing quality, hospital infection management and infectious disease management. Additionally, an analysis was carried out on failure to practice according to law in mental health institutions. Results Among the 68 medical and healthcare institutions, 47 (69%) reached the pass line in the assessment, and 21 (31%) still failed. Among the 14 cities with districts, the highest score was 87.85 points, and the lowest score was 42.09 points. Radar charts indicated that the overall diagnosis and treatment quality in primary and private medical institutions was not high. The hospital infection management and infectious disease management in the psychiatric departments of primary medical institutions and general hospitals were notably weak. A total of 45 mental health institutions were punished for not practicing according to law, of which 24 (53.33%) used non-health technicians to engage in medical and health work, and 8 (17.78%) did not implement the medical quality management system in accordance with regulations. Conclusions The diagnosis and treatment quality of primary and private medical and healthcare institutions in Guangxi needs to be improved urgently. The hospital infection management and infectious disease management in the psychiatric departments of primary medical institutions and general hospitals need to be strengthened. There is a significant gap in the quality of mental health services in regions, and healthcare institutions fail to practice according to law.
  • Research on the construction of quality evaluation index system of contracted family doctor services
    XU Zhongqin, LONG Jiang, CHENG Chunmei, XU Hong
    Soft Science of Health. 2024, 38(4): 71-73. https://doi.org/10.3969/j.issn.1003-2800.2024.04.016
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    Based on the Service Quality (SERVQUAL) Model, a quality evaluation index system for contracted family doctor services is constructed by using literature analysis and expert consultation. This index system includes five primary indicators, including tangibility, reliability, responsiveness, assurance and empathy, as well as 24 secondary indicators, which provides an effective evaluation tool for scientific evaluation of the quality of contracted family doctor services.
  • Exploration of cost optimization of anaesthesia in hysteroscopy day surgery used monitored anesthesia care—measured with time-driven activity-based costing
    HUANG Yu, XU Yan, ZHOU Rui, GU Dan, LUO Fang, ZHANG Wei
    Soft Science of Health. 2024, 38(4): 74-77. https://doi.org/10.3969/j.issn.1003-2800.2024.04.017
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    This paper reviews hysteroscopy day surgery in Tiantan Hospital from October 2021 to September 2022. The cost of anesthesia is calculated through the time-driven activity-based costing (TDABC) model, and perioperative adverse events are recorded. The cost of anesthesia and safety of monitored anesthesia care (MAC) in hysteroscopy day surgery are evaluated. 717 patients completed hysteroscopy under anesthesia, of which 466 received MAC and 251 received general anesthesia (GA). The average anesthesia cost in MAC group is 889.84 yuan per case, which is significantly lower than that in GA group (1143.57 yuan per case, P<0.0001). The incidence of perioperative adverse events in MAC group (3.65%) is not statistically significant compared with that in GA group (6.37%) (P=0.0965), and there are no serious adverse consequences in both groups. Multivariate linear regression shows that the cost of anesthesia in MAC group is correlated with patients' age, the length of operation and anesthesia duration (P<0.01). As a safe and effective anesthesia technology, MAC can significantly reduce anesthesia costs. Anesthesiologists can use the TDABC model for cost accounting while optimizing clinical pathways and cost control.
  • Application, challenges and countermeasures of ChatGPT in the construction of smart TCM hospitals
    LI Qiyuan, ZHANG Jing, XU Quanguang, ZHUANG Yiqiang, GONG Wenjin
    Soft Science of Health. 2024, 38(4): 78-81. https://doi.org/10.3969/j.issn.1003-2800.2024.04.018
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    The generative artificial intelligence represented by ChatGPT brings opportunities and challenges to the construction of smart TCM hospitals. This paper discusses the application of ChatGPT in helping the inheritance and development of TCM experience, assisting young TCM practitioners to improve the quality of diagnosis and treatment, improving the operation and management efficiency of TCM hospitals, and realizing the whole life cycle health management, and points out that its application faces many challenges, such as the traditional concepts of both doctors and patients, the weak information foundation of TCM hospitals, the defects of generative artificial intelligence technology, and the imperfect management system and supervision system. It is necessary to adjust cognition to establish the correct concept about generative artificial intelligence; strengthen the construction of information infrastructure of TCM hospitals; encourage research and development of generative artificial intelligence technologies; improve the management system and supervision system; and promote the rational application of generative artificial intelligence technology in the smart area of traditional Chinese medicine hospitals.
  • Current situation and thinking of long-term care insurance system in China—based on the comparative analysis of policies of pilot cities in Chengdu and Shanghai
    DU Kuan, HU Yiran, LIU Yuan
    Soft Science of Health. 2024, 38(4): 82-87. https://doi.org/10.3969/j.issn.1003-2800.2024.04.019
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    Since China launched the pilots of long-term care insurance system in 2016, various cities have conducted beneficial exploration on the financing mechanism, coverage, treatment payment and service supply of long-term care insurance in practice. Through the pilot experience of long-term care insurance in Chengdu and Shanghai, the paper compares the similarities and differences of the policies of the two cities, summarizes the problems existing in the two pilot cities. It is proposed to improve long-term care insurance system by expanding the financing channels of long-term care insurance, establishing a reasonable financing mechanism, constructing and improving the service supply system of long-term care insurance, strengthening the supervision and management of long-term care insurance, and improving the long-term care insurance market.
  • Current situation and countermeasures of Internet addiction among college students
    ZHANG Ruijia, HU Jinchen, TAN Jianfeng, SUN Xiaoyuan, WAN Chonghua
    Soft Science of Health. 2024, 38(4): 88-94. https://doi.org/10.3969/j.issn.1003-2800.2024.04.020
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    Objective To analyze the current situation and influencing factors of Internet addiction among college students, and propose countermeasures accordingly. Methods 3092 college students in a medical university were investigated by self-made questionnaire, Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder Scale (GAD-7) and Internet Addiction Disorder Questionnaire (IADQ). Chi-square test was used in univariate analysis and multiple logistic regression was used in multivariate analysis to screen the related factors affecting Internet addiction. Results Univariate analysis showed that parents' education level, family relationship, household economic situation, depression and anxiety had statistical significance on Internet addiction among college students. Multiple logistic regression analysis showed that taking the students who were not diagnosed as Internet addiction as reference, depression and anxiety had statistical significance on the probability of college students who were diagnosed as high risk of Internet addiction and the Internet addiction. Family economic status and parents' education level were statistically significant on the probability of college students diagnosed as high risk of Internet addiction and the Internet addiction. Conclusions College students' Internet addiction is related to parents' education level, family relationship, household economic situation and their own psychological status.
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