Analysis and enlightenment of medical alliance cooperation under Luohu global budget based on game theory / 中华医院管理杂志

Luohu District of Shenzhen has implemented the global budget management mode as " surplus reward, no compensation for overspending and reasonable sharing" in the hospital group, which continued to strengthen cooperation, optimize services, reduce costs, and improve health outcomes. The authors employed the game theory to build a game model of medical alliance under Luohu global budget management mode, discussing the reasons of medical and health institution′s stronger cooperation and what could be improved in Luohu′s case. Based on the experience of Luohu total budget management, it is suggested that when implementing total budget, all localities should improve closed-loop management, expand coverage, adopt compound medical insurance payment method, promote outpatient coordination, strengthen assessment and incentives, so as to give full play to the incentive role of total budget.

The Impact of Global Budget on the Hospitalization Beneficial Degree under New Rural Cooperative Medical System / 中国卫生经济

Objective:To analyze the effect of global budget of New Rural Cooperative Medical System (NCMS) on the per-visit inpatient compensations,inpatient compensation ratios,per-visit inpatient out-of-pocket expenses and inpatient out-of-pocket rates.Methods:The difference in difference method was used to control the non-intervention factors and estimate the net impact of global budget.Results:Global budget of NCMS decreased the per-visit inpatient compensations by 14.37 yuan,but it had no statistical significance.The compensation ratio of hospitalization increased by 5.23％,the average hospitalization self-payment decrease by 141.51 yuan,the self-payment decreased by 5.23％,which all had statistical significance while there were differences on the effects for specific diseases.Conclusion:Global budget of NCMS increased the inpatient benefit,but the effect was varies by conditions.In addition,measurement of global budget's standard still needed to be scientific and reasonable.

Revelation of the second-generation national health care reform in Taiwan area on the equity and sustainability of the medicare fund in mainland China / 中国卫生政策研究

This paper analyzes the reform backgrounds, mechanisms and measures of financing and payment taken in the second-generation national health insurance (NHI) in Taiwan. The results indicate that in 2nd NHI, the rate was adjusted more flexibly, supplementary insurance premium was charged to enlarge the financial source by im-plicating additional subsidies and expanding the sources of financing, multiple payment methods and auxiliary assis-tive means were used to control the growth of medical expenses, social insurance payments are specified in terms of category or clear payment projects and standards, new health technology assessments are used as new basis for deci-sion making, etc. by greatly alleviating the financial deficit, which helped achieve the financial balance again. Many features of the 2nd NHI in Taiwan, especially like its diversified financial resources and financing methods, global budget of control fees and DRGs payment systems, making evaluation criteria for medical quality control and health insurance reimbursement project development and so on, are worth learning for the mainland China.

Exploration and Effect of Performance-based Prospective Global Budget Payment Mechanism in Integrated Service Reform / 中国卫生经济

Objective:To explore and test a blending prospective payment that suitable for integrated care delivery system in China.Methods:Referring to Accountable Care Organization and domestic reforms,it designed a performance-based and prospective global budget payment mechanism which mainly contained strategies as medical alliance contract,prepay by DRGs and performance-based management.Through a quasi-experiment,it tested its effects on controlling the inpatient spending and continuity of care.Results:There were 38 980 cases included from inpatient claims data out of 4 towns.194 medical records came from township and county hospitals.Compared to control group,the average hospitalization rate per capita every 5 months in treated group significantly declined by 0.08％,the likelihood of using upper level hospitalization significantly declined by 0.16％,and the continuity of care significantly increased by 33.80％.Global budget system would benefit decreasing hospitalization structure and improving medical collaboration.However,the effects of new model might be underestimated by the imperfect implementation of compulsory referral system.Conclusion:The medical alliances should center on combined objectives as stimulating medical cooperation and improving on quality of care.It should make the blending prospective payment decisions on basis of information-shared grading and referral medical system and empirical evidence.

Discussions on the present practice and problems of global budget in China / 中华医院管理杂志

Based on a definition of the concept and its connotation,and summary of the evolution and practice of global budget in China,this paper focused on analyzing the existing problems,namely a defective mechanism in the determination and adj ustment of the total budget,unreasonable settlement, absence of a regulatory mechanism and poor linkage of this system with other payment modes reform.Thus the authors proposed such policy recommendations as designated management of those covered by health insurance,and experiments with the global budget mode for regional groups,scientific estimation and adj ustment of the total budget,reasonable setting of settlement standards and rules,and enhanced supervision and appraisal,as well as various payment system reforms based on global budget.

Study of the impacts of global budget on service efficiency and costs of hospital services in Shanghai / 中华医院管理杂志

Objective To analyze such indices as quantity of care,bed turnover,medical costs and medical insurance in Shanghai′s tertiary hospitals,before and after the implementation of the global budget for a study of the present medical insurance payment in Shanghai.Methods With SPSS 21.0,this thesis conducted a descriptive statistic analysis on changes of such indices as service volume,and efficiency in medical services,medical costs,before and after the implementation of the global budget.Results After the implementation,the year-on-year growth of the number of outpatients and emergency visits,and patients discharged decreased about 4.0%in such hospitals.From 2008 to 2012,the average days of stay dropped by 4.0 days in total.Before the implementation,the growth rate of total costs of medical services was 21.7%,which was only 12.6%in 2012.For those patients under coverage,the number of outpatients and emergency visits,and inpatients discharged kept increasing since 2010.The ratio of total medical insurance cost in the total medical costs fell below 39.0%,dropping year on year.The accumulated completion rate of medical insurance is over 100.0%each year,with overspending each year as well,and such total for drugs covered by medical insurance falls below 100.0%each year.Conclusion The global budget helps push up volume and efficiency of medical services,and helps control medical expense significantly.However,quality of care for patients is expected to improve,and so is further control over the total amount of global budget.

Design and application of the medical insurance information management platform in the context of global budget / 中华医院管理杂志

The implementation of the global budget system requires the hospitals to be supported by advanced medical insurance information management systems.The design and application of the medical insurance information management platform at the hospital can optimize management processes,improve the management level,save management costs,establish database,and promote the development of medical insurance.

Effect on implementation of global budge：Based on micro-data of four pilot hospitals in Beijing / 中国卫生政策研究

Payment system reforms have become an important part of Chinese healthcare reforms, and global budget has been seen as a major trend. Based on the practice and data of four pilot hospitals in Beijing which have implemented the global budget, this paper focuses on analyzing the effects of implementation on the following aspects and provides references for policy improvements: medical services, average medical cost, total health expenditure, medical cost structure, average length of stay and out-of-pocket expense percentages.

Forecasting the Future Reimbursement System of Korean National Health Insurance: A Contemplation Focusing on Global Budget and Neo-KDRG-Based Payment Systems

With the adoption of national health insurance in 1977, Korea has been utilizing fee-for-service payment with contract-based healthcare reimbursement system in 2000. Under the system, fee-for-service reimbursement has been accused of augmenting national healthcare expenditure by excessively increasing service volume. The researcher examined in this paper two major alternatives including diagnosis related group-based payment and global budget to contemplate the future of reimbursement system of Korean national health insurance. Various literature and preceding studies on pilot project and actual implementation of Neo-KDRG were reviewed. As a result, DRG-based payment was effective for healthcare cost control but low in administrative efficiency. Global budget may be adequate for cost control and improving the quality of healthcare and administrative efficiency. However, many healthcare providers disagree that excess care arising from fee-for-service payment alone has led to financial deterioration of national health insurance and healthcare institutions should take responsibility with global budget payment as an appropriate solution. Dissimilar payment systems may be applied to different types of institutions to reflect their unique attributes, and this process can be achieved step-by-step. Developing public sphere among the stakeholders and striving for consensus shall be kept as collateral to attain the desirable reimbursement system in the future.

Survey on medical insurance expenditure control policy in Shanghai's tertiary first-class hospitals / 上海第二医科大学学报

Objective To investigate the current policy of medical insurance expenditure control in Shanghai and put forward feasible advice. Methods Survey in 5 tertiary first-class hospitals in Shanghai involving 400 doctors and patients was conducted.The result of the questionnaire was tracked with Microsoft Excel 2000.The expense reports during 2001 to 2006 from the Office of Medical Insurance of Shanghai Renji Hospital was collected.All the data were statistically analysed. Results The global budget system was accepted by both the doctors and patients.Charging based on disease categories was proved a relatively satisfying method.Drug expenditure control was concerned by both the doctors and patients. Conclusion Ever since the global budget system of medical insurance is implemented in Shanghai,the medical insurance expenditure has been effectively controlled.The key point is the restraint of irrational consumption during the medical treatment.