Evaluating the results of applying case based payment method for normal delivery cases at Thanhnhan hospital, Hanoi (2012-2014)

Objectives: To evaluate the results from the implementation of case-based payment method for normal delivery at Thanhnhan Hospital, 2012 - 2014, to compare the length of stay and level of drugs used between two groups of women applying and not applying case-based payment method and evaluate the service’s quality and acceptability to the new payment method.

JOURNAL OF MILITARY PHARMACO-MEDICINE N09-2017 EVALUATING THE RESULTS OF APPLYING CASE-BASED PAYMENT METHOD FOR NORMAL DELIVERY CASES AT THANHNHAN HOSPITAL, HANOI (2012 - 2014) Chu Phuc Thi*; Pham Le Tuan**; Hoang Hai*** SUMMARY Objectives: To evaluate the results from the implementation of case-based payment method for normal delivery at Thanhnhan Hospital, 2012 - 2014, to compare the length of stay and level of drugs used between two groups of women applying and not applying case-based payment method and evaluate the service’s quality and acceptability to the new payment method Subjects and methods: This is a study of hospital cost analysis, using both quantitative and qualitative methods Data related to treatment costs of all women giving births at Thanhnhan Hospital from January 2012 to December 2014, who voluntarily chosen the payment methods, were collected and analyzed using SPSS 20.0 Information from in-depth interviews with health care providers, mothers and health insurance experts was analyzed and cited according to subject matters Results: Applying case-based payment method has encouraged the hospital to use resources reasonably and controlled cost raising of normal delivery cases Group of normal delivery women applying case-based payment method had average length of stays lower than that of group which did not apply, ranging from 3.7% to 6.87%; the average costs of drug was also lower among the mothers applying case-based payment method at about 17.73% to 92.91%; average of total cost in the group applying case-based payment method was lower than that of women who not apply from 31.05% to 62.05% All comparisons were significant at p value = 0.05 The women in both groups had satisfied with the quality of services received and the stakeholders support the new payment mechanism Conclusions : The casebased payment method could be an appropriate option for Vietnamese hospitals for controlling and limiting the cost increase * Keywords: Payment method; Case-based payment; Normal delivery; Thanhnhan Hospital INTRODUCTION Reforming the mechanism of operation and management of health financing and hospital payment system are the priorities for Vietnam to promote the development of the health sector in an equitable, effective and sustainability manner [3] In order to achieve this goal, the Ministry of Health has piloted case-based payment method at Thanhnhan and Bavi Hospitals from 2009 to 2011, and then extended the implementation from 2012 to 2014 New payment method should be studied and evaluated scientifically in order to make * Thanhnhan Hospital ** Ministry of Health *** Vietnam Military Medical University Corresponding author: Chu Phúc Thi (thichu70@gmail.com) Date received: 18/08/2017 Date accepted: 23/11/2017 158 JOURNAL OF MILITARY PHARMACO-MEDICINE N09-2017 accurate conclusions Therefore, we conducted a study to evaluate the implementation of case-based payment method for normal delivery cases at Thanhnhan Hospital, from 2012 to 2014 with the following objectives: - Comparing the length of stay and level of drugs used between two groups of women applied and not applied casebased payment method - Assessing the service’s quality and acceptability for the new payment method SUBJECTS AND METHODS Subjects and sample size - All women giving births at Thanhnhan Hospital from January 2012 to December 2014, who voluntarily selected using casebased payment method - Intentionally select one hospital leader, two clinical staff members in the obstetric department, one health insurance expert, and 22 normal delivery women for in-depth interviews Methods * Research design: Study of hospital cost analysis, combined both quantitative and qualitative methods * Viewpoint: Service provider fees (Hospital charge) * Study variables: - Average length of stay, mean of drug charge, average total charge for a normal delivery case - Quality of normal delivery services and acceptability for case-based payment method * Data collection and processing: Data on inpatient charges were extracted from hospital financial software during 2012, 2013 and 2014 MSSQR software was used to pairing the birth records with charged items and length of stay; export the data to Excel spreadsheet for cleaning; Data were then entered, managed and analyzed using SPSS 20.0 statistical software In-depth interviews were synthesized, analyzed and cited according to subject matters RESULTS AND DISCUSSIONS Evaluating the results of applying case-based payment method for normal delivery cases Table 1: Average length stay of normal delivery, Thanhnhan Hospital, 2012 - 2014 Year 2012 2013 Statistics Non case-based payment group Case-based payment group Comparing between groups Mean  SD 3.34  0.84 3.23  0.56 -3.70% (p < 0.05) Median 3 - N 1,329 222 - Mean  SD 3.28  0.76 3.13  0.47 -4.75% (p < 0.05) Median 3 - N 1,310 196 - 159 JOURNAL OF MILITARY PHARMACO-MEDICINE N09-2017 2014 Total Mean  SD 3.33  1.13 3.11  0.43 -6.87% (p < 0.05) Median 3 - N 986 161 - Mean  SD 3.32  0.90 3.16  0.86 -4.88 (p < 0.05) Median 3 - N 3,625 579 - The average length of stay (LOS) in the group applying case-based payment method was 3.23, 3.13 and 3.11 days, in the group of non-case-based payment method was 3.34, 3.28 and 3.33 days in 2012, 2013, and 2014, respectively The comparison between the two groups, applying and not applying case-based payment method, showed that the group which applied new payment method had an average LOS less than that of the non-applied group of 3.7%, 4.75% and 6.87%, respectively in 2012, 2013 and 2014 and statistically significant at p < 0.05 Table 2: Average medication costs of normal delivery at Thanhnhan Hospital, 2012 - 2014 Unit: VND Year Statistics Non case-based payment group Case- based payment group Comparing between groups Mean  SD 170,056  134,638 119,464  46152 42.35% (p < 0.05) Median 159,990 110,750 - N 1,329 222 - Mean  SD 203,132  180,534 105,297  26,892 92.91 (p < 0.05) Median 131,315 100,351 - N 1,310 196 - Mean  SD 124,793  148,385 106,004  23,154 17.73% (p < 0.05) Median 95,204 102,359 - N 986 161 - Mean  SD 169,698  159,225 110,926  35,387 -52.98% (p < 0.05) Median 125,562 104,168 - N 3,625 579 - 2012 2013 2014 Total Total drug costs in the group of case-based payment method was 119,464 VND in 2012 to 105,297 VND in 2013 and 106,004 VND in 2014 The comparison between the two groups showed that the drug cost was lower in the group applied case-based payment method from 17.73% to 92.91% and statistically significant at p < 0.05 160 JOURNAL OF MILITARY PHARMACO-MEDICINE N09-2017 Table 3: Average of total hospital charges (excluding costs of subclinical tests), normal delivery case, Thanhnhan Hospital, 2012 - 2014 Unit: VND Year Statistics Non case-based payment group Case-based payment group Mean  SD 818,677  279,872 624,724  102,461 Comparing between groups -31.05% (p < 0.05) 2012 Median 793,016 619,365 - N 1,329 222 - Mean  SD 956,146  284,776 590,043  104,772 -62.05% (p < 0.05) 2013 Median 935,594 613,324 - N 1,310 196 - Mean  SD 1,023,967  241,523 651,893  62,401 -57.08% (p < 0.05) 2014 Median 971,570 648,180 - N 986 161 - Mean  SD 924,194  284,625 620,359  96,908 -48.93% (p < 0.05) Total Median 901,178 631,566 - N 3625 579 - The total mean cost (excluding costs for subclinical testing) in the normal delivery group applying case-based payment method was often lower than that of non-case-based payment group at 31.05%, 62.05% and 57.08% for 2012, 2013 and 2014, respectively (p < 0.05) Average for years, the average charges of normal delivery group applying case-based payment method was 48.93% lower than that in the group not applying case-based payment method The results from applying case-based payment method clearly demonstrated the effect of reducing the average number of treatment days, reducing drug costs, and limiting cost increases when applying new payment method for normal delivery at Thanhnhan Hospital Similar results also had been reported in piloting period 2009 2011 [2] and in other international research reports [4, 5] Results of the study in Italy in 2011 showed that the average cost for the normal delivery births which applied fee for services method was 1,166.83 euros; 263.89 euros (26%) higher than that of diagnosis-related group (DRG) payment method (922.94 euros) [6] 161 JOURNAL OF MILITARY PHARMACO-MEDICINE N09-2017 Quality of service and acceptability for new payment methods In addition to the benefits achieved by applying the case-based payment method, some other aspects need to be considered concurrently [1] We assessed at and compared the variables of the average length of stay and drug costs The results showed that no patient was discharged early and no excessive cost was cut: two aspects that usually negatively affect the quality of treatment for patients Results of in-depth interviews of women with or without case-based payment method showed that they were satisfied with the services received during the labor and delivery at Thanhnhan Hospital Women of both groups reported that there were no differences in term of care at the obstetric department, for some aspects of quality that the women can observe and assess by themselves (the attitudes, counseling provision to women about postpartum care, drug use, medical materials and services at the maternity ward) Health insurance and clinical staff at Thanhnhan Hospital said that there was no reduction in giving drugs and subclinical tests for women applying case-based payment method to limit the costs, because there must be a compliance with the requirements of the clinical pathway Data on costs collected also proved this matter Similar results were also indicated in other countries which applying case base payment method [4, 5] Stakeholders who involved in new payment method: service users, representatives of health insurance agency (service buyer) and Thanhnhan Hospital (service provider) expressed their support to case-based 162 payment method due to the benefits gained, although there were some areas that need to be improved so that new payment modality could be deployed on a large scale CONCLUSIONS The cased-based payment method could be an appropriate option for Vietnamese hospitals, for controlling and containing the cost increases, promoting reasonable use of resources, improving quality of treatment services Stakeholders (clinical staff, hospital leader, health insurance staff and service users) support the adoption of case-based payment method REFERENCES Ministry of Health, the Planning Department Hospital fee for services, case-based payment method 2007 Nguyen Thi Thuy Nga, Bui Thi My Anh Overview of methods of payment for health insurance services for providers in Vietnam Journal of Medicine Practice 2013, 874 (6), pp.179-182 Pham Le Tuan Renovating the financial mechanism to achieve the goal of universal health care coverage Second Health Economics Conference, Hanoi, November 2012 Ministry of Health 2012, pp.25-43 Cheryl Cashin, Sheila O Dougherty et al Case-based hospital payment systems: A step by step guide for design and implementation in low and middle income countries USAID ZdravPlus Project 2005 John C Langenbrunner et al Designing and implementing health care provider payment systems How to manuals The World Bank and the USAID 2009 Pizzo Elena An estimate of costs and benefits of alternative methods of delivery: an empirical analysis Imperial College, London 2011  ... subject matters RESULTS AND DISCUSSIONS Evaluating the results of applying case- based payment method for normal delivery cases Table 1: Average length stay of normal delivery, Thanhnhan Hospital,. ..JOURNAL OF MILITARY PHARMACO-MEDICINE N09-2017 accurate conclusions Therefore, we conducted a study to evaluate the implementation of case- based payment method for normal delivery cases at Thanhnhan. .. in the group not applying case- based payment method The results from applying case- based payment method clearly demonstrated the effect of reducing the average number of treatment days, reducing