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Costing Study of Health Services Items for National Health Insurance Scheme Establishment in China.
*Ying Bian, National Institute of Health Policy and Management  

Keywords: Public Hospitals, Health Service Items, Costing Study, Relative value

In the past six decades from 1949 there is no national health insurance scheme in China. There is the beginning from 2003 that China start to establish the rural health insurance scheme and from 2007 the urban health insurance intend to merge into the rural health insurance scheme, the purpose is to establish the National Health Insurance Scheme in the whole country. But unfortunately, there is no costing study project in China, and current payment mechanism is based on health services items. This research project granted by Ministry of Health, China Central Government during the past 10 years, and this project will provide the basic costing information both for national health insurance establishment also for health payment mechanism reform in China near future. Objectives of this project are: (1)To analysis the current cost situation of hospital in different level; (2)To establish the relative value system of health service items; (3) To calculate the unit cost of health services items based on the relative value system; (4)To analysis the financial channel. Methodology: Totally there are 85 hospitals from 10 provinces were surveyed for costing data collection. Step-down cost allocation was used for cost study, calculate the department cost and unit cost of per visit, per bed-day, per discharged patients. Results: 1?Hospital total cost and unit cost: The average total cost of hospital is 6429 Yuan, and among this drug cost is 2840 Yuan account for 44% of total cost, health service cost is 3589 Yuan account for 56%. 2. Compare of relative value, cost and standard user-fee: the relative value of each health services items (totally 3966 items) built up through the fuzzy mathematical model. 3. Unit cost of health service items: Most of the items have lower cost recovering. The result of compare study indicated that there are 79.6% services items are cost higher than standard user-fee. 4.Revenue cost balance: average income is 67 million, compared with eth cost 64 million the net benefit is 3 million, ratio is 4.5%. Recommendations were derived from the study. 1. Recommendation for hospital management, to establish the basis of costing evaluation mechanism for better cost monitoring. The special unit of costing analysis should be establish, the costing study should be combined with hospital accounting. 2. Recommendation for health policy: The price adjustment system should be established based on the costing information.