Using the Method of Medical Insurance Payment Reform to Promote the Path Selection of Large Hospital Development
Science Journal of Public Health
Volume 7, Issue 2, March 2019, Pages: 53-58
Received: Apr. 19, 2019;
Published: May 23, 2019
Views 665 Downloads 101
Pengyu Xu, School of Business Administration, Andrews University, Berrien Springs, USA
At the beginning of the establishment of the basic medical insurance system in China, the primary implementation was a single project-based payment. At present, it has gradually explored a single or mixed way to pay, mainly including payment by disease type, payment by the number of people, payment by medical service unit and payment by the DRGs (Diagnosis Related Group System). This paper discusses the reform of payment mode of basic medical insurance in large hospitals and summarizes the main features of the reform of the payment mode of basic medical insurance in the past. First of all, the basic medical insurance management department has absolute choice and pricing power. The government is responsible for the management of basic medical insurance, and the hospital is in a state of passive implementation of government policies. In addition, the reasonable demands of large hospitals can hardly be effectively reflected in the policy. Last but not least, the improvement of hospital serviceability and the promotion of patients' reasonable medical treatment effect have not been realized effectively. The research results of this paper mainly discuss the reform path of basic medical insurance payment methods in large hospitals. For one thing, large hospitals can proactively report to the basic medical insurance management department the reformed disease types and disease charges for basic medical insurance payments. For another thing, the large hospitals can determine the diagnosis and treatment plan of the disease according to the clinical path of disease diagnosis and treatment. The basic medical insurance management department can explore the new path method of reforming the basic medical insurance payment method in large hospitals according to the reform idea of “the same disease insurance standards are consistent” and individual “differentiated self-payment." At the same time, it is recommended that the government use the professional management ability of commercial insurance companies to improve the performance of basic medical insurance by purchasing commercial insurance company services. Give play to the third-party role of commercial insurance companies to help alleviate the asymmetry of the hospital and patient medical information and the contradiction between doctors and patients.
Using the Method of Medical Insurance Payment Reform to Promote the Path Selection of Large Hospital Development, Science Journal of Public Health.
Vol. 7, No. 2,
2019, pp. 53-58.
Z. “Opinions of the Central Committee of the Communist Party of China and the State Council on Deepening the Reform of the Medical and Health System,” China Government Network, 2009, pp. 1-8.
R. Qinyue Meng, Hongwei Yang, Wen Chen, Qiang Sun, Xiaoyun Liu, “China's health system in transition,” World Health Organization Asia Pacific Health System and Policy Watch, 2016 (7), pp. 15.
H. Hang Chen, “Medical Reform of The Supply Side——The study of cooperation mode choice about hierarchical diagnosis and treatment,” Beijing: Chemical Industry Press, 2017, pp. 1-10.
Z. “Several opinions of the State Council's Leading Group on Deepening the Reform of the Medical and Health System on Further Promoting the Experience of Deepening the Reform of the Medical and Health System,” China Government Network, 2016, pp. 1-4.
J. Xiaolin He, Ping Jiang, Minjie Zhu, Lei Xu, Wei Lu, “The government collaboration and medical insurance to boost: ‘The Four medical linkage’ under the protection of family doctor service,” Chinese Journal of Health Policy, 2017 (10).
J. Fulin Chu, “Establishing a value-based medical insurance payment system” China Health Insurance, 2017 (11).
Z. “Guiding Opinions of the General Office of the State Council on Further Deepening the Reform of Basic Medical Insurance Payment Methods,” China Government Network, 2017, pp. 1-5.
J. Jingyu Yang, Wu Yan, “The reform of medical insurance payment system is the key to play the basic role of medical insurance,” China medical insurance, 2016 (12).
Z. “Guiding Opinions of the General Office of the State Council on the Pilot Reform of Urban Public Hospitals,” China Government Network, 2015, pp. 1-4.
J. Debin Xu, Junhua Hua and Weijie Li, “China Life Insurance undertakes the experience and thinking of the major illness insurance for urban and rural residents,” Jiangsu Insurance, 2017 (10), pp. 27-30.
J. “Fuling Zhu. Establishing a value-oriented medical insurance payment system,” China Medical Insurance, 2017 (11), pp. 34-35.
J. Ting Pan, Wei Du, “The Construction Practice of Wisdom Unified Settlement & Payment Platform Mode in Wuhai,” China Digital Medicine, 2017, 12 (9), pp. 21-23.
Z. “Several opinions of the State Council on accelerating the development of modern insurance service industry,” China Government Network, 2014, pp. 1-6.
J. Debin Xu, Aihua Jiang and Yindong Wen, “Commercial insurance company undertakes the risk identification, measurement and control research of urban and rural residents' major illness insurance business,” Jiangsu Insurance, 2018 (2), pp. 31-38.
M. Thomson Sarah, Bussen Reinhard, Crivelli Luca, Wynand van de Vend and Carine Van de Voorde, “Statutory health insurance competition in Europe: A four-country comparison,” Health Policy, 2013 (109), pp. 209–225.
R. “China commercial health insurance research,” China development research foundation, 2017, pp. 14.