It is the core of provider payment reform in healthcare that payment methods can be chosen correctly.According to the framework of contract theory,this paper compared the“pricing cost”and“monitoring cost”between diagnosis related groups perspective payment system(DRGs-PPS)and feefor-service.And then,based on contract theory,this paper further turn to analyzed the main management problems during the implementation of DRGs-PPS,and put forward relevant policies key points from the aspects of“monitoring”and“maintaining”.This paper drawn the basic conclusions that,comparing to feefor-services,DRG-s-PPS have relative low transaction; therefore,the transformation from fee-for-service to DRGs-PPS will benefit the virtuous circle of the healthcare market.However,DRGs-PPS is new deal for China,so it need to be pushed forward steadily with the full consideration of healthcare regulations and system maintenance.

Objective: To study the influence of contractual medical association on inpatient service performance. Methods:The data came from“Database of Inpatient Record” administered by Department of Medical Insurance. Using diagnosis related groups ( DRG) as the tool of risk-adjustment, the third-tier general hospitals and second-tier general hospitals in medical alliance as the intervention group, and the average level of the same grade local hospitals as the control group, the influence of medical alliance on inpatient service performance was evaluated. The difference in difference ( DID) method was used for the data analysis. The assessing indicators included the number of DRG group, case mix index ( CMI) , the total weight, cost efficiency index and time efficiency index. Results:After the establishment of medical association, compared with the average level of the same grade local hospitals, in the third-tier general hospitals of medical alliance, the growth rate of the total weight had declined, and cost efficiency index had increased, while in the second-tier general hospitals of medical alliance, the CMI value had de-clined, and the cost efficiency index had increased. Conclusion:Contractual medical association played a role of triage patients, and improved the service levels and management efficiency of the second-tier general hospitals.

Objective:To study the substitution effect of outpatient services on inpatient services and provide suggestions on designing outpatient policies. Methods:The data were from 13 districts/counties in one area of eastern China from 2007 to 2013 for the new cooperative medical scheme. This study em-ployed a fixed effects model to analyze the impacts of outpatient visit times, expenditure amounts and re-imbursements on inpatient services. Results: One outpatient visit reduced the total amount of inpatient services by 20 Yuan. An increase of 10 000 Yuan outpatient reimbursements saved 9 700 Yuan inpatient expenses. An increase of 10 000 Yuan outpatient expenses led to a decrease of 3 000 Yuan inpatient re-imbursements. The outpatient services did not increase the inpatient hospitalization times significantly. In particular, the effects of the outpatient services were mainly on the inpatient services at the district/coun-ty levels, and no significant impacts on the outpatient services at the city levels. Conclusion:There is a substitution effect of outpatient services on inpatient services. The health insurance departments should take this substitution effect into account and shift more funds on outpatient series, when they design out-patient and inpatient reimbursement policies.

Neuropathic pain is a common chronic pain with complicated underlying mechanisms and difficult to treat, which badly disturbs the daily life of the patient and presents a significant burden to society by increasing healthcare resource utilization and costs. In the recent years, the pivotal role of glia-centered neuroinflammation and neuroimmunity in the development and maintenance of neuropathic pain has been recognized gradually. This review presents the current understanding of the role of glia in neuropathic pain and therapies of glia modulation.

Objective: To assess and analyze the operation efficiency of 8 commission general public hospitals managed directly by National Health and Family Planning Commission and 8 municipal general hospitals managed directly by Beijing Municipal Administration of Hospitals in Beijing and to provide suggestions on improving service capacity and designing relevant health policy.Methods: Input and output data of 8 commission hospitals and 8 municipal hospitals were obtained from Beijing Direct-Reported Health Statistics data from 2011 to 2014.Data envelopment analysis was used as the hospital operation efficiency measurement tool.The CCR and BCC models were built to calculate technical efficiency (TE), pure technical efficiency (PTE), scale efficiency (SE) and the status of scale efficiency of 16 hospitals in 2011 and 2014;the Malmquist index model was built to analyze the total factor productivity change (TFPC), technological change (TC), technical efficiency change, pure technical efficiency change and scale efficiency change of the 16 hospitals from 2011 to 2014.Results: In 2011, the TE, PTE and SE of the commission hospitals were higher than those of the municipal hospitals, and the TEs of the commission hospitals and the municipal hospitals were 0.918 and 0.873 respectively.In 2014, the TE, PTE and SE of commission hospitals were lower than those of the municipal hospitals, and the TE of the commission hospitals and the municipal hospitals were 0.906 and 0.951, respectively, which was contrary to the results in 2011.According to the Malmquist index model, the average of TFPC of the municipal hospitals was larger than that of the commission hospitals, the former increased 5.9% and the latter increased 2.8% per year;the average of TC was greater than the one in both the municipal hospitals and the commission hospitals, with a growth of 3.2% and 2.9% per year, respectively;the average growth of PTE in the commission hospitals was lower than that of the municipal hospitals, and the average descent of SE in the commission hospitals was larger than that in the municipal hospitals.Conclusion: There are significant differences in the operation efficiency between different management systems and the main factors associated with operation efficiency are the technological and management level.Given scale efficiency status and macroeconomic medical policies, the commission hospitals and the municipal hospitals require further adjusting the distribution of medical resources, and it is of great significance for all the commission hospitals and the municipal hospitals to improve the management level and resource integration capability.

Objectives: China has observed an increasing prevalence of cardiovascular diseases among its population, which is putting heavy economic burden both on individuals and the whole society.Conducting a multi-angle study of cardiovascular patients with economic burden can help adjust the health care policy to reduce the economic burden of patients.Methods: Using the baseline data (2011) and follow-up data (2013) of the China Health and Retirement Longitudinal Survey, this study selected cardiovascular patients aged 45 and above to calculate their direct medical cost, direct non-medical cost as well as self-paid cost before and after reimbursement.The total cost and self-paid cost are both calculated, and gender difference and rural-urban difference are also analyzed.Results: The prevalence of cardiovascular disease among the population age 45 and above was 13.9% in 2013 and 12.1% in 2011, while the prevalence in women was higher than in men and urban areas higher than rural areas.The average annual total costs for individual patient before reimbursement in 2013 was lower than that in 2011, but contrary to the trend of self-pay costs.Urban patients had higher amount of direct medical cost, lower co-payment rate and lower non-medical cost such as transportation and accommodation than their rural counterpart.Both urban and rural patients self-paid more on outpatient services than inpatient services.Conclusion: Based on these analyses, this paper suggests that Chinese policy makers should look deeper into patient behaviors as well as their economic burden before revising the current health policy.More practices regarding to the unbalanced distribution of health resources between urban and rural areas are needed, in order to ensure patients living in remote areas could get access to appropriate treatment without paying heavy non-medical cost.

ObjectiveTo imitate the process of identifying episode separations,which helps to improve the methodology of control episode separations.Methods Abstracts of inpatient record on all patients discharged from the hospitals in Beijing in 2010 were drawn from Beijing Public Health Information Center.Risk-adjusted by Diagnosis Related Groups-Beijing version (BJ-DRGs),two-weeks readmission rate was calculated at the whole city and hospital levels respectively.Comparing the readmission rate between these two levels,“suspicious objects”of episode separations can be found.In turn,the episode separations can be identified by detail analysis of these suspicious objects.Results In 2010,there were 13 DRGs with readmission rate exceeding 10％.Take the cases of dementia and other chronic brain disorders for example,the readmission rate for this type of inpatients in hospital G was much higher than the average level of the whole city.After the detail analysis of hospital G,the episode separations were found.Conclusion It is an effective method to indentify episode separations that calculating readmission rate based on the DRG risk-adjustment and using city level readmission rate as bench-mark.

Objective:To study direct medical cost of hypertensive patients without complicated disea-ses,to analyze substitution impacts of outpatient expenditure on inpatient expenditure,and then to make recommendations to health policy makers and hypertensive patients for managing hypertension.Methods:The claims data of hypertensive patients insured by the rural new cooperative medical scheme in a city in northern China from 2008 to 201 3 were analyzed,descriptive statistics employed to analyze direct medical cost of hypertensive patients and hypertensive patients without complicated diseases which was one of the three groups divided by medical treatment conditions (hypertension without complicated diseases,hyper-tension with complicated diseases,and other diseases),and the differences between groups compared by t test.The fixed effect two-part model was employed to analyze the substitution effect of outpatient services on inpatient services,and specific effects of outpatient times and reimbursement expenses on the inpatient expenditure were calculated by Logistic regression analysis.Results:For the hypertensive pa-tients,the average cost of outpatients was 283.49 Yuan in 2008 and rose to 370.93 Yuan in 201 3.After being divided into three groups,for hypertensive patients without complicated diseases,the average cost of outpatient was 449.79 Yuan in 2008 and rose to 582.53 Yuan in 201 3.In the total cost of the outpa-tient,45.73% was for the hypertensive patients without complicated diseases;in the total cost of the in-patient,only 9.29% was for the hypertensive patients without complicated diseases.By calculating the marginal effect of parameter estimation through the fixed effect two-part model,the inpatient cost could be significantly reduced by increasing the visit times of outpatient utilization or the cost of outpatient reim-bursement.For example,in 201 3,a 1 % rise of outpatient visit times increased outpatient expenditures by 6.48 million Yuan,which could reduce inpatient expenditures by 39.86 million Yuan.The substitu-ted ratio of outpatient cost on inpatient cost had been around 5 in 201 0 and later.Conclusion:The health policy-makers and hypertensive patients should pay more attentions to the substitution of outpatient cost for inpatient cost,especially for the hypertensive patients without complicated diseases whose direct medical cost was mainly due to outpatient rather than inpatient costs.

Authors described characteristics of medical service performance evaluation,and strategy options for scientifically evaluating such performance,and systematically presented the conditions and methodology of DRGs-based evaluation of medical service performance.Six evaluation indicators were cited in terms of the capacity,efficiency and medical safety of medical service providers,with detailed introduction to the computation process of such indicators.Cases in hand indicate that the first-page data completeness and accuracy of medical records are preconditions for using DRGs in medical service performance evaluation.

ObjectiveTo evaluate the performance of diagnosis-related groups,Beijing version (BJ-DRGs) which were locally developed in Beijing.MethodA total of 1.3 million inpatient records from 149 hospitals in Beijing in 2008 were drawn from Beijing Public Information Center.Coefficient of variation (CV) was used to measure the performance of DRGs system.ResultsBJ-DRGs produced the best CV results for expenditure.ConclusionsUnder Beijing's medical information condition,BJ-DRGs produced good performance.