ABSTRACT
OBJECTIVE：To provide reference for deepening the reform of medical insurance payment mode in China. METHODS：By analyzing the specific reform process and driving factors of American Medicare ，and considering the background of current payment reform in China ，then some suggestions were put forward to promote the reform of medical insurance payment mode in China. RESULTS & CONCLUSIONS ：The payment mode of Medicare in the United States had undergone three stages ， which were post-payment system ，pre-payment system and value-based payment system. The payment modes included payment by service items ，payment by disease diagnosis related groups （DRGs）and payment by service value. The change was the result of the comprehensive effect of the three systems of technology ，politics and social culture in the United States. The demand for reasonable treatment and control fees drove the change from post-payment system to pre-payment system ，while the crisis of service quality ， the rise of service cost and the contradiction between doctors and patients drove the change to value-based payment. Payment mode reform had a positive impact on Medicare in the United States ，reducing medical expenditure and improving the quality of service. It is suggested that China should draw lessons from the experience of the United States in reforming the prepayment system nationwide on the basis of the current DRGs pilot projects. Meanwhile ，in order to avoid the medical quality crisis in the later period of the United States ，it is necessary to introduce the concept of value-based payment ，establish incentive and restraint mechanisms and strengthen the construction of the regulatory supporting system for the whole process.
ABSTRACT
Objective To provide reference for optimizing the procedure of service to patients by comparing the effectiveness between the two payment modes.Methods 497 patients were divided into the experimental group and the control group, and key indexes from the two groups was comparatively analyzed.Result There is no statisti-cally significant in payment complexity between the two groups(P<0.05).However, the effectiveness of mode trans-formation in the experimental group was dramatically higher than that in the control group, which has statistically sig-nificance ( P<0.05) .Conclusion The experimental group of mode transformation has a remarkably higher effec-tiveness than that in the control group, and thus it is worthy of promotion and application.
ABSTRACT
This article elaborated the connotation of public hospital medical insurance payment system and the importance of reform,summarizing and analyzing the practical exploration of promoting medical insurance payment system reform in the localities.Then it moved on to introduce new progress of medical insurance payment system reform abroad and the emerging mode of medical insurance payment, such as pay for performance,payment by results,and bundled payment.In the end,the authors put forward policy suggestions to improve medical insurance payment system at public hospitals in China, namely to build a modern healthcare payment system in line with the needs of medical service system.Such a system should be guided by comprehensive performance,restrained by cost budgeting, based on a diversified payment mode,and supported by information technology.In addition,it should have scientific payment standard and modern governance mechanism,and keep interactive development with commercial health insurance.
ABSTRACT
The paper analyzes from the angles of the parties providing, needing and paying for medical and health services the factors influencing the medical insurance system and discusses the features of reform directions in the medical insurance payment system, viz. the move of payment from an open to a closed mode and from a single to a mixed mode and the move of the main bodies controlling medical insurance expenses from expenses controlling centers to resources controlling centers. The single mode of payment by service procedures adopted in the current medical insurance system in China must therefore be replaced by a diversified mode of payment and corresponding supporting measures ought to be taken. In the meantime, hospital medical cost accounting ought to form a system that includes department cost accounting, medical procedure cost accounting and disease entity cost accounting.