Objective:This study aims to explore the benefit analysis of the same disease in different departments of public hospitals under the DIP payment method.Methods:This study is a retrospective analysis that selected clin...Objective:This study aims to explore the benefit analysis of the same disease in different departments of public hospitals under the DIP payment method.Methods:This study is a retrospective analysis that selected clinical data from patients who received treatment in the Department of Orthopedics and the Department of Acupuncture and Moxibustion at our hospital from January 1,2023,to December 31,2023.The study compared the costs of medications,examinations,treatments,laboratory tests,nursing and other expenses,and total treatment costs between the two departments.It analyzed the cost structure of the two departments and proposed further improvement suggestions.Results:The study results indicated that the total costs in the Department of Acupuncture and Moxibustion were significantly higher than those in the Department of Orthopedics.Among medication costs,the total medication costs in the Department of Orthopedics were higher than those in the Department of Acupuncture and Moxibustion,with costs for Western medicine,proprietary Chinese medicine,and herbal medicine all being higher(p<0.05).Regarding examination costs,consultation fees in the Department of Orthopedics were lower than those in the Department of Acupuncture and Moxibustion,while examination costs were higher(p<0.05).In terms of treatment costs,orthopedic treatment and surgical fees were higher than those in the Department of Acupuncture and Moxibustion(p<0.05).For laboratory test costs,orthopedic laboratory fees were significantly higher than those in the Department of Acupuncture and Moxibustion(p<0.05).Among nursing and other expenses,orthopedic blood transfusion,bed fees,and other expenses were higher than those in the Department of Acupuncture and Moxibustion,while nursing fees were lower(p<0.05).Conclusion:Treatment fees in the Department of Acupuncture and Moxibustion are the core and account for a relatively high proportion of the total costs.The benefits generated by the Department of Orthopedics are primarily derived from medication,examination,and laboratory fees,aligning with the characteristics of combining diagnosis,medication,and surgical intervention in orthopedic treatment.Consultation fees,nursing fees,and bed fees in the Department of Acupuncture and Moxibustion are higher than those in the Department of Orthopedics,indicating a longer treatment cycle in acupuncture,which warrants clinical attention.展开更多
Objective To study the innovative drug pricing methods and medical insurance payment standards in foreign countries and to provide reference for China’s government.Methods The official websites were searched for info...Objective To study the innovative drug pricing methods and medical insurance payment standards in foreign countries and to provide reference for China’s government.Methods The official websites were searched for information and related literature,and literature review was used.Results and Conclusion In foreign countries,the clinical value of innovative drugs and their impact on medical insurance funds were comprehensively evaluated based on factors such as quality-adjusted life years,clinical benefit,and improvement of clinical benefit.Then,the evaluation results were taken as an important basis for whether innovative drugs were admitted to the medical insurance catalog and establishing medical insurance payment standards.By using international experience for reference,innovative drug pricing methods and medical insurance payment standards for China’s national conditions can be improved by establishing a basic database of clinical value and drug economic evaluation of innovative drugs,as well as innovative drug payment models based on decision thresholds.展开更多
Operational risk events have severely impacted the development of third-party payment(TPP)platforms,and have even led to a discussion on the operational risk capital charge settlement by relevant international regulat...Operational risk events have severely impacted the development of third-party payment(TPP)platforms,and have even led to a discussion on the operational risk capital charge settlement by relevant international regulators.However,prior studies have mostly focused on qualitative mechanism analysis,and have rarely examined quantitative risk assessment based on actual operational risk events.Therefore,this study attempts to assess the operational risk on TPP platforms in China by constructing a systematic framework incorporating database construction and risk modeling.First,the operational risk database that covers 202 events between Q1,2014,and Q2,2020 is constructed.Then,specific causes are clarified,and the characteristics are analyzed from both the trend and loss severity perspectives.Finally,the piecewise-defined severity distribution based-Loss Distribution Approach(PSD-LDA)with double truncation is utilized to assess the operational risk.Two main conclusions are drawn from the empirical analysis.First,legal risk and external fraud risk are the two main causes of operational risk.Second,the yearly Value at Risk and Expected Shortfall are 724.46 million yuan and 1081.98 million yuan under the 99.9%significance level,respectively.Our results are beneficial for both TPP platform operators and regulators in managing and controlling operational risk.展开更多
The In most contingent valuation (CV) studies, WTP (Willingness to pay) and WTA (Willingness to accept) were often used separately, so protesting or no response or even babbling answers are increasing, and the debate ...The In most contingent valuation (CV) studies, WTP (Willingness to pay) and WTA (Willingness to accept) were often used separately, so protesting or no response or even babbling answers are increasing, and the debate persists over the reliability of CV in economic policy analysis. In order to improve the reliability of CV, WTP and WTA is used syn-chronously to estimate the restoration cost of Maqu grassland ecosystem. Data were partly from questionnaire survey, and partly from interviews and authorities. Before conclusions were derived, we assumed these data that came from interviews and authorities were right. The main result is: If we assumed that the degraded grassland of Maqu needs 10 years to be restored, and divided the restoring period into two stages, then the restoration cost was 0.85 × 108 RMB per year in former 4 years, 0.022 × 108 RMB per year in latter 6 years. The total cost of Maqu grassland restoration was 3.62 × 108 RMB. For all the costs of restoration, WTA occupied 94% and WTP only occupied 6%, suggesting that local grassland degradation was mainly caused by overgrazing and that the overloading livestock must be eliminated in order to achieve restoration successfully. Our research also showed that combining WTP and WTA in contingent valuation is very useful in estimating the cost of environmental improvement projects. Of course, whether these results are right or not, further researches are needed in the future, especially for the actual number of livestock in Maqu grassland.展开更多
China's Mainland has witnessed remarkable achievements in payment innovations based on internet and financial technologies in recent years,whereas Macao has made little progress in financial technologies,especiall...China's Mainland has witnessed remarkable achievements in payment innovations based on internet and financial technologies in recent years,whereas Macao has made little progress in financial technologies,especially in payment technologies.Based on the concept and types of third-party payment business in China's Mainland and Macao,as well as to investigate the causes for Macao’s lack of innovation in third-party payment,this study compares their differences from two aspects:business licensing authorities and key points of supervision.By comparison,although the classification and methods of third-party payment businesses are different between China's Mainland and Macao,they are all managed and licensed by a unified supervision department.Moreover,the key points of supervision in both places are similar,but unlike China's Mainland,which takes financial risk prevention as the principle and financial technology as the means to encourage innovation,Macao showed obvious deficiencies.In order to further deepen the connection between the financial markets of China's Mainland and Macao as well as boost financial technologies in Macao,this study aims to provide some suggestions and references for the development of cross-border payment systems.展开更多
目的分析新医改以来我国医保支付方式改革的政策现状与不足,为完善医保支付方式改革提供参考。方法运用ROST CM 6软件梳理2009—2024年国家层面出台的医保支付方式改革政策文件,明确此阶段重点推行的主要支付方式并构建政策一致性(Polic...目的分析新医改以来我国医保支付方式改革的政策现状与不足,为完善医保支付方式改革提供参考。方法运用ROST CM 6软件梳理2009—2024年国家层面出台的医保支付方式改革政策文件,明确此阶段重点推行的主要支付方式并构建政策一致性(Policy Modeling Consistency,PMC)指数评价指标体系对其政策文本进行量化及比较分析。结果疾病诊断相关分组(DRG)与按病种分值付费(Diagnosis-Intervention Packet,DIP)支付方式的词频数远高于其他医保支付方式,是国家医保支付方式改革政策制定的侧重点。DRG政策的PMC指数均值为5.76,DIP政策的PMC指数均值为6.25,总体上DIP支付方式政策质量更高。结论新医改以来政策迭代驱动多元复合支付体系构建,医保支付方式改革进入精准发展阶段,2类主要医保支付方式中DIP政策数量与词频数低于DRG政策,但其政策质量却高于DRG政策,另外二者政策存在短期导向、视角局限与激励不足等共性问题。建议出台加强DRG/DIP与其余支付方式的联合使用政策,推动医保支付方式改革发展。展开更多
目的基于德尔菲法筛选出国家医疗保障疾病诊断相关分组(ChinaHealthcare Security Diagnosis Related Groups,CHS-DRG)付费下医保基金监管指标,提高医疗机构医保基金监管效能。方法采用德尔菲法,选择医保专业领域专家32人,通过两轮专家...目的基于德尔菲法筛选出国家医疗保障疾病诊断相关分组(ChinaHealthcare Security Diagnosis Related Groups,CHS-DRG)付费下医保基金监管指标,提高医疗机构医保基金监管效能。方法采用德尔菲法,选择医保专业领域专家32人,通过两轮专家问卷咨询,设计CHS-DRG付费下医保基金监管指标测评量表。咨询结果从积极性、权威性、协调性等3个方面进行测评。结果构建基于医保基金使用质量、效率和安全监管3个维度的医保基金监管指标体系,包含3个一级指标、7个二级指标、44个三级指标。结论CHS-DRG付费下医保基金监管指标体系构建应尊重临床诊疗实际,强化智能化监管方式,及时干预医保基金管理风险。展开更多
目的:系统分析各类医生薪酬支付方式对医疗服务提供行为及结果的影响。方法:采用范畴综述法,以Web of Science和中国知网、维普及万方为数据源,“医生”“薪酬”“支付方式”和“医生行为”等为主题词,检索到相关文献2255篇,通过制定严...目的:系统分析各类医生薪酬支付方式对医疗服务提供行为及结果的影响。方法:采用范畴综述法,以Web of Science和中国知网、维普及万方为数据源,“医生”“薪酬”“支付方式”和“医生行为”等为主题词,检索到相关文献2255篇,通过制定严格的筛选程序最终纳入70篇相关研究。结果:按项目支付激励医生提供足量服务,但易导致过度医疗;固定薪水与按人头支付有助于控制成本,但易引发服务不足;DRG/DIP在医疗服务数量与质量方面的优势随患者病情加重而减弱。混合支付方式能够有效平衡医疗服务数量与成本,而按绩效支付在医疗质量提升方面总体表现突出。结论:医生薪酬单一支付方式难以实现医疗服务提供行为及结果最优化,且质量导向不足,多种支付方式与质量激励相融合的混合支付体系亟待构建。同时,建议深化医保结余薪酬转化机制改革,充分落实公立医院分配自主权,加快建立与医保支付和绩效考核协同的医生薪酬混合支付方式。展开更多
文摘Objective:This study aims to explore the benefit analysis of the same disease in different departments of public hospitals under the DIP payment method.Methods:This study is a retrospective analysis that selected clinical data from patients who received treatment in the Department of Orthopedics and the Department of Acupuncture and Moxibustion at our hospital from January 1,2023,to December 31,2023.The study compared the costs of medications,examinations,treatments,laboratory tests,nursing and other expenses,and total treatment costs between the two departments.It analyzed the cost structure of the two departments and proposed further improvement suggestions.Results:The study results indicated that the total costs in the Department of Acupuncture and Moxibustion were significantly higher than those in the Department of Orthopedics.Among medication costs,the total medication costs in the Department of Orthopedics were higher than those in the Department of Acupuncture and Moxibustion,with costs for Western medicine,proprietary Chinese medicine,and herbal medicine all being higher(p<0.05).Regarding examination costs,consultation fees in the Department of Orthopedics were lower than those in the Department of Acupuncture and Moxibustion,while examination costs were higher(p<0.05).In terms of treatment costs,orthopedic treatment and surgical fees were higher than those in the Department of Acupuncture and Moxibustion(p<0.05).For laboratory test costs,orthopedic laboratory fees were significantly higher than those in the Department of Acupuncture and Moxibustion(p<0.05).Among nursing and other expenses,orthopedic blood transfusion,bed fees,and other expenses were higher than those in the Department of Acupuncture and Moxibustion,while nursing fees were lower(p<0.05).Conclusion:Treatment fees in the Department of Acupuncture and Moxibustion are the core and account for a relatively high proportion of the total costs.The benefits generated by the Department of Orthopedics are primarily derived from medication,examination,and laboratory fees,aligning with the characteristics of combining diagnosis,medication,and surgical intervention in orthopedic treatment.Consultation fees,nursing fees,and bed fees in the Department of Acupuncture and Moxibustion are higher than those in the Department of Orthopedics,indicating a longer treatment cycle in acupuncture,which warrants clinical attention.
文摘Objective To study the innovative drug pricing methods and medical insurance payment standards in foreign countries and to provide reference for China’s government.Methods The official websites were searched for information and related literature,and literature review was used.Results and Conclusion In foreign countries,the clinical value of innovative drugs and their impact on medical insurance funds were comprehensively evaluated based on factors such as quality-adjusted life years,clinical benefit,and improvement of clinical benefit.Then,the evaluation results were taken as an important basis for whether innovative drugs were admitted to the medical insurance catalog and establishing medical insurance payment standards.By using international experience for reference,innovative drug pricing methods and medical insurance payment standards for China’s national conditions can be improved by establishing a basic database of clinical value and drug economic evaluation of innovative drugs,as well as innovative drug payment models based on decision thresholds.
基金supported by grants from the National Natural Science Foundation of China(71425002,72101166)the Capital University of Economics and Business for the Fundamental Research Funds for Universities affiliated to Beijing(XRZ2021066).
文摘Operational risk events have severely impacted the development of third-party payment(TPP)platforms,and have even led to a discussion on the operational risk capital charge settlement by relevant international regulators.However,prior studies have mostly focused on qualitative mechanism analysis,and have rarely examined quantitative risk assessment based on actual operational risk events.Therefore,this study attempts to assess the operational risk on TPP platforms in China by constructing a systematic framework incorporating database construction and risk modeling.First,the operational risk database that covers 202 events between Q1,2014,and Q2,2020 is constructed.Then,specific causes are clarified,and the characteristics are analyzed from both the trend and loss severity perspectives.Finally,the piecewise-defined severity distribution based-Loss Distribution Approach(PSD-LDA)with double truncation is utilized to assess the operational risk.Two main conclusions are drawn from the empirical analysis.First,legal risk and external fraud risk are the two main causes of operational risk.Second,the yearly Value at Risk and Expected Shortfall are 724.46 million yuan and 1081.98 million yuan under the 99.9%significance level,respectively.Our results are beneficial for both TPP platform operators and regulators in managing and controlling operational risk.
文摘The In most contingent valuation (CV) studies, WTP (Willingness to pay) and WTA (Willingness to accept) were often used separately, so protesting or no response or even babbling answers are increasing, and the debate persists over the reliability of CV in economic policy analysis. In order to improve the reliability of CV, WTP and WTA is used syn-chronously to estimate the restoration cost of Maqu grassland ecosystem. Data were partly from questionnaire survey, and partly from interviews and authorities. Before conclusions were derived, we assumed these data that came from interviews and authorities were right. The main result is: If we assumed that the degraded grassland of Maqu needs 10 years to be restored, and divided the restoring period into two stages, then the restoration cost was 0.85 × 108 RMB per year in former 4 years, 0.022 × 108 RMB per year in latter 6 years. The total cost of Maqu grassland restoration was 3.62 × 108 RMB. For all the costs of restoration, WTA occupied 94% and WTP only occupied 6%, suggesting that local grassland degradation was mainly caused by overgrazing and that the overloading livestock must be eliminated in order to achieve restoration successfully. Our research also showed that combining WTP and WTA in contingent valuation is very useful in estimating the cost of environmental improvement projects. Of course, whether these results are right or not, further researches are needed in the future, especially for the actual number of livestock in Maqu grassland.
基金Special Project of Guangdong Provincial Key Discipline Project“Public Management”-Research on Information Literacy of Teachers and Students in Colleges and Universities from the Perspective of Crisis and Emergency Management(Key Construction Discipline of Guangdong Provincial Education Department in 2016)The Second Batch of Teaching Quality and Teaching Reform Project of Guangzhou Xinhua University in 2021-Finance Course Teaching and Research Department(Project Number:2021JYS001)。
文摘China's Mainland has witnessed remarkable achievements in payment innovations based on internet and financial technologies in recent years,whereas Macao has made little progress in financial technologies,especially in payment technologies.Based on the concept and types of third-party payment business in China's Mainland and Macao,as well as to investigate the causes for Macao’s lack of innovation in third-party payment,this study compares their differences from two aspects:business licensing authorities and key points of supervision.By comparison,although the classification and methods of third-party payment businesses are different between China's Mainland and Macao,they are all managed and licensed by a unified supervision department.Moreover,the key points of supervision in both places are similar,but unlike China's Mainland,which takes financial risk prevention as the principle and financial technology as the means to encourage innovation,Macao showed obvious deficiencies.In order to further deepen the connection between the financial markets of China's Mainland and Macao as well as boost financial technologies in Macao,this study aims to provide some suggestions and references for the development of cross-border payment systems.
文摘目的基于德尔菲法筛选出国家医疗保障疾病诊断相关分组(ChinaHealthcare Security Diagnosis Related Groups,CHS-DRG)付费下医保基金监管指标,提高医疗机构医保基金监管效能。方法采用德尔菲法,选择医保专业领域专家32人,通过两轮专家问卷咨询,设计CHS-DRG付费下医保基金监管指标测评量表。咨询结果从积极性、权威性、协调性等3个方面进行测评。结果构建基于医保基金使用质量、效率和安全监管3个维度的医保基金监管指标体系,包含3个一级指标、7个二级指标、44个三级指标。结论CHS-DRG付费下医保基金监管指标体系构建应尊重临床诊疗实际,强化智能化监管方式,及时干预医保基金管理风险。
文摘目的:系统分析各类医生薪酬支付方式对医疗服务提供行为及结果的影响。方法:采用范畴综述法,以Web of Science和中国知网、维普及万方为数据源,“医生”“薪酬”“支付方式”和“医生行为”等为主题词,检索到相关文献2255篇,通过制定严格的筛选程序最终纳入70篇相关研究。结果:按项目支付激励医生提供足量服务,但易导致过度医疗;固定薪水与按人头支付有助于控制成本,但易引发服务不足;DRG/DIP在医疗服务数量与质量方面的优势随患者病情加重而减弱。混合支付方式能够有效平衡医疗服务数量与成本,而按绩效支付在医疗质量提升方面总体表现突出。结论:医生薪酬单一支付方式难以实现医疗服务提供行为及结果最优化,且质量导向不足,多种支付方式与质量激励相融合的混合支付体系亟待构建。同时,建议深化医保结余薪酬转化机制改革,充分落实公立医院分配自主权,加快建立与医保支付和绩效考核协同的医生薪酬混合支付方式。
