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.
Trang 1EVALUATING 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 do 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 do support the new payment mechanism Conclusions : The
case-based 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
Trang 2accurate 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
case-based payment method
acceptability for the new payment method
SUBJECTS AND METHODS
1 Subjects and sample size
- All women giving births at Thanhnhan
Hospital from January 2012 to December
2014, who voluntarily selected using
case-based 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
2 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
1 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
payment group
Case-based payment group
Comparing between 2 groups
2012
2013
Trang 32014
Total
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
payment group
Case- based payment group
Comparing between
2 groups
2012
(p < 0.05)
2013
(p < 0.05)
2014
(p < 0.05)
Total
(p < 0.05)
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
Trang 4Table 3: Average of total hospital charges (excluding costs of subclinical tests),
normal delivery case, Thanhnhan Hospital, 2012 - 2014
Unit: VND
payment group
Case-based payment group
Comparing between
2 groups
2012
(p < 0.05)
2013
(p < 0.05)
2014
(p < 0.05)
Total
(p < 0.05)
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 3 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]
Trang 52 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
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
1 Ministry of Health, the Planning Department
Hospital fee for services, case-based payment method 2007
2 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
3 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
4 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
5 John C Langenbrunner et al Designing
and implementing health care provider payment systems How to manuals The World Bank and the USAID 2009
6 Pizzo Elena An estimate of costs and
benefits of alternative methods of delivery:
an empirical analysis Imperial College, London
2011