公立医院 “成本病” 与医疗负担——兼论 “药品零加成” 政策的影响

公立医院是我国医疗卫生体系的主体,是新医改成功的关键,但多年来缺乏完善的成本核算体系,也加重了患者和政府的医疗负担。文章利用2013-2018年中部某省658家公立医院数据,基于Baumol"成本病"理论,构造新的"调整的鲍莫尔变量",首次从微观视角检验公立医院"成本病"的存在性,并考察了"成本病"是否加重了患者和政府负担;进一步结合"药品零加成"政策的实施,探究了其对公立医院"成本病"效应的影响。研究发现,我国公立医院系统同样存在"成本病"现象,且是加重患者与政府医疗负担的重要原因;"成本病"对患者医疗负担的影响并无医院等级差异,对政府医疗支出的影响在二级医院更为明显。结合样本期内"药品零加成"政策的实施发现,政策有效降低了患者负担,但加重了政府医疗支出,也未能缓解公立医院的"成本病"问题,但有助于医技成本支出的降低。研究具有重要的政策启示:"成本病"已经成为制约公立医院可持续发展的重要影响因素,亟需建立有效的成本核算管理工具和机制,健全公立医院薪酬制度,促进公立医院管理向精细化、规范化转型,抑制"成本病"问题,保障公立医院健康、可持续发展。     

A multiple criteria sorting method for supporting the maintenance management of medical ventilators: The case of Hospital da Luz Lisboa

Medical equipment is characterized by a constant flow of innovations, which is transforming the delivery of healthcare. This creates the need for healthcare organizations to incorporate methodologies to support the maintenance management of these equipment. Within this context, Luz Saúde, the holding company of one of the largest healthcare groups in Portugal, intends to complement the medical equipment maintenance management program of the biggest hospital in its network, Hospital da Luz Lisboa. To this aim, we develop a decision aiding tool for assessing the maintenance condition of medical ventilators and recommend a plan of action. For that, we apply a multicriteria decision aiding methodology, utilizing the Electre Tri-nC method. In interaction with the decision makers, we construct a model using twelve criteria for assigning ventilators to one of the five ordered categories representing the current condition (excellent, very good, good, adequate, and poor). Most of the medical ventilators in the analysis were considered in adequate or good maintenance conditions, which was consistent with the decision makers’ expectations. A detailed analysis of the results evidenced the robustness of the model. This study constitutes the first step toward the use of multicriteria methodologies for supporting decision processes in Hospital da Luz Lisboa.     

A dual-clustering algorithm for a robust medical grid partition problem considering patient referral

The medical grid including hospitals at all levels is a new hierarchical diagnosis and treatment system. It is assumed to provide health services for residents in a certain area, allowing free referral of patients, so as to effectively utilize medical resources. Therefore, from the perspective of the government, the key issue is how to divide the medical grid in a robust and balanced manner. In this paper, various deterministic factors, such as hospital level, location and department, as well as uncertain factors, including patient distribution or population density, are considered in decision-making. To solve this problem, a dual-clustering algorithm based on K-means and K-medoids (DCKK) is developed with local search methods to minimize the average patient waiting and travelling time. The experimental results show that DCKK algorithm can generate better and more robust grid partition solutions than the existing mainstream algorithms in different scenarios. In addition, the rules between the number of medical grids and the number of patients, as well as the hospital sharing between medical grids, are also studied. Finally, a real medical grid partition case of Ji'nan, China, with forty hospitals in four urban areas, is studied, and five medical grids are recommended.     

大病保险对中老年居民医疗利用及健康的影响——基于CHARLS数据的实证检验

运用CHARLS 2011、2013、2015年三期数据,采用双重差分模型和准自然实验框架,分析城乡居民大病保险制度对中老年居民医疗服务利用和健康的影响及其作用机制,并从城乡和收入两个角度对制度实施效应的异质性进行探究。研究表明:大病保险制度实施能够显著促进中老年居民住院医疗服务及健康,增加中老年居民住院概率1.03%,提高住院次数0.022次,提高住院总费用10.4个百分点,总体健康水平提高0.023个单位;制度实施主要促进了农村和中等收入群体的住院医疗服务利用和健康水平的改善,对低收入人群住院医疗服务影响有限,且对城镇居民和高收入群体的影响并不显著;作用机制分析显示大病保险制度实施通过提高居民医疗服务利用进而起到改善其健康水平的作用。研究表明大病保险制度对中老年居民的住院服务利用和健康起到积极作用,但对于低收入群体的效应仍有待进一步改善。     

How to improve IFRS for intangible assets? A milestone approach

This study focuses on the decreasing relevance of financial information associated with current financial reporting standards for intangible assets. We summarize and compare three approaches to improving financial reporting standards for internally generated intangibles—the recognition approach, the fair value approach and the disclosure approach, among which we focus on the recognition approach. We investigate the impact of current International Accounting Standard 38 on the R&D capitalization policies of the high-tech industry, particularly among medical device firms in China. We conclude that the current recognition criteria are so stringent that they disincentivize firms from capitalizing their R&D investments. A large variation exists in capitalization timing within the medical device industry. Accordingly, we propose the milestone approach to revising financial reporting standards for intangible assets. We suggest that determining the capitalization criteria for intangibles based on the R&D cycle and capitalization timing should be moved forward.