Comparing financing models for supplementary healthcare in appendectomy: activity-based costing (fee-for-service) vs. diagnosis related group remuneration (bundled payment): a systematic review and meta-analysis

Purpose: In Brazil, healthcare services traditionally follow a fee-for-service (FFS) payment system, in which each medical procedure incurs a separate charge. An alternative reimbursement with the aim of reducing costs is diagnosis related group (DRG) remuneration, in which all patient care is covered by a fixed amount. This work aimed to perform a systematic review followed by meta-analysis to assess the effectiveness of the Budled Payment for Care Improvement (BPCI) versus FFS. Methods: Our work was performed following the items of the PRISMA report. We included only observational trials, and the primary outcome assessed was the effectiveness of FFS and DRG in appendectomy considering complications. We also assessed the costs and length of hospital stay. Meta-analysis was performed with Rev Man version 5.4. Results: Out of 735 initially identified articles, six met the eligibility criteria. We demonstrated a shorter hospital stay associated with the DRG model (mean difference = 0.39; 95% confidence interval ­ 95%CI ­ 0.38­0.40; p < 0.00001; I2 = 0%), however the hospital readmission rate was higher in this model (odds ratio = 1.57; 95%CI 1.02­2.44, p = 0.04; I2 = 90%). Conclusions: This study reveals a potential decrease in the length of stay for appendectomy patients using the DRG approach. However, no significant differences were observed in other outcomes analysis between the two approaches.

Analysis of payment models applied to federal funding from the perspective of the Brazilian Health System

Objective: This study aims at identifying the payment methods existing in the Unified Health System referring to federal transfers to Primary Health Care (PHC) and Specialized Health Care. Methods: A quantitative and analytical study was carried out, developed in three stages: survey of all types of transfers from the Union; classification of each transfer category according to the types of payment methods and measurement of the participation of each payment methods, according to the financing components analyzed, in relation to the net values transferred. Results: Federal transfers were classified into seven payment methods. For PHC, in 2020, approximately R$ 21.7 billion was calculated, including resources destined for the pandemic, and R$ 20.9 billion without considering resources to face the COVID-19 pandemic. More than 50% of the amounts used were classified as capitation, in both cases. For specialized health care, in 2019, around R$ 48.5 billion were calculated, and in 2020 more than R$ 49.2 billion. For the two years, more than 70% of the funds were allocated to fee for service. Conclusions: This study allowed for an expansion in knowledge about the allocation of resources referring to transfers from the Union to states, the Federal District and municipalities. As the payment methods are related to productivity, access and quality of the health service, knowing and identifying the most appropriate payment methods for each situation contributes to the achievement of the goals and to the mitigation of eventual losses of efficiency in the healthcare systems.

Análise dos modelos de pagamento aplicados ao financiamento federal na perspectiva do Sistema Único de Saúde / Analysis of payment models applied to federal funding from the perspective of the Brazilian Health System

Objetivo: Este estudo tem por objetivo identificar os modelos de pagamento existentes no Sistema Único de Saúde referentes aos repasses federais para a Atenção Primária à Saúde (APS) e a Atenção Especializada à Saúde. Métodos: Foi realizado um estudo quantitativo e analítico, desenvolvido em três etapas: levantamento de todos os tipos de repasse da União; classificação de cada categoria de repasse segundo os tipos de modelos de pagamentos; e mensuração da participação de cada modelo de pagamento, de acordo com os componentes de financiamento analisados, em relação aos valores líquidos repassados. Resultados: Os repasses federais foram classificados em sete modelos de pagamentos. Para a APS, em 2020, foram apurados R$ 21,7 bilhões, aproximadamente, incluindo os recursos destinados para a pandemia, e R$ 20,9 bilhões, sem considerar os recursos para enfrentamento da pandemia de COVID-19. Mais de 50% dos valores empregados foram classificados como capitação, em ambos os casos. Para a Atenção Especializada à Saúde, em 2019, foram computados em torno de R$ 48,5 bilhões e, em 2020, acima de R$ 49,2 bilhões. Para os dois anos, mais de 70% dos recursos foram destinados a pagamentos por procedimento. Conclusões: Este estudo permitiu a ampliação do conhecimento sobre a alocação dos recursos referentes aos repasses da União para estados, Distrito Federal e municípios. Como os modelos de pagamentos estão relacionados com a produtividade, acesso e qualidade do serviço de saúde, conhecer as formas de pagamento e identificar a mais adequada para cada situação contribui para o alcance das metas e para a mitigação de eventuais perdas de eficiência nos sistemas de saúde.

Objective: This study aims at identifying the payment methods existing in the Unified Health System referring to federal transfers to Primary Health Care (PHC) and Specialized Health Care. Methods: A quantitative and analytical study was carried out, developed in three stages: survey of all types of transfers from the Union; classification of each transfer category according to the types of payment methods and measurement of the participation of each payment methods, according to the financing components analyzed, in relation to the net values transferred. Results: Federal transfers were classified into seven payment methods. For PHC, in 2020, approximately R$ 21.7 billion was calculated, including resources destined for the pandemic, and R$ 20.9 billion without considering resources to face the COVID-19 pandemic. More than 50% of the amounts used were classified as capitation, in both cases. For specialized health care, in 2019, around R$ 48.5 billion were calculated, and in 2020 more than R$ 49.2 billion. For the two years, more than 70% of the funds were allocated to fee for service. Conclusions: This study allowed for an expansion in knowledge about the allocation of resources referring to transfers from the Union to states, the Federal District and municipalities. As the payment methods are related to productivity, access and quality of the health service, knowing and identifying the most appropriate payment methods for each situation contributes to the achievement of the goals and to the mitigation of eventual losses of efficiency in the healthcare systems.

Review and inspirations of the payment mechanism of Long-Term Care Hospital of Medicare of the United States / 中华医院管理杂志

A type of designated hospitals in Medicare is referred to as Long-Term Care Hospital (LTCH). LTCH is one of Post-Acute Care settings(I. e. Intermediate care)and the only facilities certified by length of stays. This article reviewed the milestones and payment methods of Medicare Long-Term Care Hospital payment system, for perfection of the medical insurance and construction of China′s intermediate care system.

The Effect of Diagnosis-Related Group Payment System on Quality of Care in the Field of Obstetrics and Gynecology among Korean Tertiary Hospitals

PURPOSE: To examine changes in clinical practice patterns following the introduction of diagnosis-related groups (DRGs) under the fee-for-service payment system in July 2013 among Korean tertiary hospitals and to evaluate its effect on the quality of hospital care. MATERIALS AND METHODS: Using the 2012–2014 administrative database from National Health Insurance Service claim data, we reviewed medical information for 160400 patients who underwent cesarean sections (C-secs), hysterectomies, or adnexectomies at 43 tertiary hospitals. We compared changes in several variables, including length of stay, spillover, readmission rate, and the number of simultaneous and emergency operations, from before to after introduction of the DRGs. RESULTS: DRGs significantly reduced the length of stay of patients undergoing C-secs, hysterectomies, and adnexectomies (8.0±6.9 vs. 6.0±2.3 days, 7.4±3.5 vs. 6.4±2.7 days, 6.3±3.6 vs. 6.2±4.0 days, respectively, all p < 0.001). Readmission rates decreased after introduction of DRGs (2.13% vs. 1.19% for C-secs, 4.51% vs. 3.05% for hysterectomies, 4.77% vs. 2.65% for adnexectomies, all p < 0.001). Spillover rates did not change. Simultaneous surgeries, such as colpopexy and transobturator-tape procedures, during hysterectomies decreased, while colporrhaphy during hysterectomies and adnexectomies or myomectomies during C-secs did not change. The number of emergency operations for hysterectomies and adnexectomies decreased. CONCLUSION: Implementation of DRGs in the field of obstetrics and gynecology among Korean tertiary hospitals led to reductions in the length of stay without increasing outpatient visits and readmission rates. The number of simultaneous surgeries requiring expensive operative instruments and emergency operations decreased after introduction of the DRGs.

Remuneración a los proveedores de servicios de salud en Bogotá / Payment to providers of health services in Bogotá

RESUMEN Objetivo Revisar los conceptos, desarrollos y efectos de los mecanismos de pago utilizados en diversos países, con el fin de proponer una metodología de pago aplicable para los hospitales de Bogotá. Método Se efectuó una revisión bibliográfica de tres aspectos de interés: conceptos esenciales, desarrollos alcanzados y efectos derivados de los mecanismos de pago utilizados en diversos países. Luego se efectuaron sesiones de trabajo entre los autores y con diversos grupos y equipos de la secretaria de salud de Bogotá, los hospitales, la academia y las autoridades nacionales en salud, para el diseño metodológico de un esquema de pago aplicable a los hospitales de la red adscrita de salud en Bogotá. Resultados La revisión bibliográfica permitió establecer los ejes de trabajo para un esquema de pago prospectivo por red con incentivos de desempeño, basado en optimización de la eficiencia técnica (provisión de servicios de salud a menor costo) y locativa (optimización de la mezcla de los servicios de salud) y en mejores resultados de atención. Discusión El esquema de reconocimiento planteado debe ser un factor integrador del proceso de atención al paciente y redundar en una mejor operación del aseguramiento, la prestación de servicios y la gobernanza de la atención en salud, al tiempo que optimiza el flujo de recursos y la sostenibilidad local del sistema.(AU)

ABSTRACT Objective To review the concepts, developments and effects of the payment mechanisms used in different countries to propose a payment methodology applicable to hospitals in Bogotá. Method Literature review in which essential concepts, developments and effects derived from payment mechanisms used in different countries were analyzed. The authors and various groups and teams of the Bogotá Health Department participated, hospitals, academia and national health authorities held work sessions with the intention of creating a methodological design for a payment scheme that could be applied to the hospitals attached to the health network in Bogotá. Results The literature review allowed establishing work axes for a prospective payment scheme per network that included performance bonuses based on the optimization of technical efficiency (provision of health services at lower cost, locative efficiency (optimization of the mix of health services), and on better care outcomes. Discussion The proposed payment scheme should be an integrating factor in the patient care process, and should also result in a better operation, service delivery and health care governance, while optimizing the flow of resources and local sustainability.(AU)

Modelo cuantitativo para mejorar el financiamiento de la atención primaria en Chile / Quantitative model to improve primary health care financing in Chile / Modelo quantitativo para melhorar o financiamento da atenção primária no Chile

RESUMEN Objetivo Proponer y aplicar una metodología para estimar el gasto esperado ajustado de cada localidad en el sistema chileno de atención primaria de la salud (APS) en el año 2016. Métodos En primer lugar, se formalizó el cálculo del gasto esperado per cápita a nivel nacional, en base a un detallado plan de salud, y luego se introdujo en este gasto un ajuste de suma cero para cada localidad a través del perfil local de sexo y edad y el promedio local del nivel socioeconómico, años de vida perdidos y ruralidad, por su incidencia estadísticamente significativa en las epidemiologías y en las estructuras de gasto. Resultados El modelo logra un vínculo conceptual y empírico entre los gastos esperados y las variables de ajuste, es flexible a mejoras sucesivas, y la propiedad de suma cero facilita la discusión del presupuesto global. En la aplicación a datos reales de Chile para el año 2016 se encuentra que la distancia absoluta entre los montos del modelo y los montos usados en dicho año es de 7,6% en promedio. Conclusiones Existen alternativas sencillas para sustentar empíricamente el cálculo de los gastos esperados a través de las localidades, para lo cual es de gran ayuda contar con una buena estimación del gasto esperado a nivel nacional.

ABSTRACT Objective Propose and apply a methodology to estimate adjusted expected expenditure in each locality in the Chilean primary health care (PHC) system in 2016. Methods First of all, expected per capita expenditure at the national level was calculated on the basis of a detailed health plan, and then a zero-sum adjustment was made to the expenditure in each locality, using the local age/sex profile and the local average socioeconomic level, years of life lost, and rurality, given their statistically significant impact on epidemiology and spending structures. Results The model establishes a conceptual and empirical link between expected expenditure and adjustment variables; it is flexible in terms of successive improvements; and its zero-sum property facilitates discussion of the global budget. When real data for the year 2016 in Chile were used, it was found that the absolute distance between the amounts in the model and the amounts actually used that year was 7.6%, on average. Conclusions There are simple empirical options for calculating expected expenditure across localities, for which it is very helpful to have a good estimate of expected expenditure at the national level.

RESUMO Objetivo Propor e implementar uma metodologia para o cálculo do gasto com saúde projetado ajustado para cada municipalidade no sistema chileno de atenção primária à saúde para o ano de 2016. Métodos Primeiro padronizou-se o cálculo do gasto per capita projetado em nível nacional, baseado em um detalhado plano de saúde. Em seguida foi feito um ajuste de soma zero no gasto com saúde para cada municipalidade segundo o perfil local de sexo e idade da população e o valor médio para nível socioeconômico, anos de vida perdidos e ruralidade de acordo com a associação de significância estatística em estudos epidemiológicos e estruturas do gasto. Resultados O modelo consegue estabelecer um vínculo conceitual e empírico entre os gastos projetados e as variáveis de ajuste, ele se adapta a melhorias sucessivas e a propriedade de soma zero facilita a discussão do orçamento global. Ao serem aplicados dados reais do Chile para 2016, observou-se uma distância absoluta entre os valores do modelo e os valores do ano considerado de, em média, 7,6%. Conclusões Existem alternativas simples para fundamentar empiricamente o cálculo do gasto com saúde projetado para as municipalidades, sendo bastante útil poder dispor de uma boa estimativa do gasto com saúde projetado em nível nacional.

Progress and implications of the DRG-based prospective payment system ( DRG-PPS ) reform in China / 中国卫生政策研究

DRG-based prospective payment system ( DRG-PPS ) is one type of mature inpatient care payment mechanisms in most countries and pilot projects would be introduced to China in 2017. This article provides an overview of the previous typical DRG-PPS reform initiatives on provincial, municipal and county level respectively. It also summa-rizes the characteristics of the reform programs, describes the diversities of policy implementation, and discusses the suc-cessful experience and implications of the initiatives. The paper puts forward some suggestions on the upcoming DRG-PPS pilot projects based on the progress and problems of the initiatives, to promote the DRG-PPS reform in China.

Associação entre fatores institucionais, perfil da assistência ao parto e as taxas de cesariana em Santa Catarina / Association between institutional factors, birth care profile, and cesarean section rates in Santa Catarina

RESUMO: Objetivo: Investigar como fatores institucionais, representados pelo perfil social da maternidade na assistência ao parto, se associam às taxas de cesariana. Métodos: Estudo com delineamento transversal com base em dados do Sistema de Informações sobre Nascidos Vivos (SINASC) para Santa Catarina. Foram selecionados, para cada uma das macrorregionais, os seis municípios com o maior número de partos. Para esses municípios, foram considerados todos os estabelecimentos que possuíam leitos obstétricos. Um total de 61.278 partos teve lugar nas 61 maternidades selecionadas. Razões de prevalência de cesariana (RP), brutas e ajustadas para confundimento, foram estimadas para cada uma das variáveis individuais por meio de Regressão de Cox Robusta. Resultados: Nascimentos por cesariana foram quase o dobro nas maternidades privadas (89%), quando comparados aos do Sistema Único de Saúde (SUS) (45,1%). Ter parto nas maternidades privadas aumentou em pelo menos 50% a ocorrência de cesariana entre as primíparas (RP = 1,64), caucasianas (RP = 1,57), mulheres com maior frequência ao pré-natal (RP = 1,54) e tendo parto diurno (RP = 1,51), quando comparadas àquelas tendo parto pelo SUS. Conclusão: Diferenças nas taxas de cesariana em favor do sistema privado, entre mulheres de melhores condições sociais, em meio às quais seria esperado menor risco obstétrico, apontaram para diferenças de permeabilidade da cultura médica/obstétrica e flexibilização na interpretação médica das indicações clínicas do parto operatório.

ABSTRACT: Objectives: To investigate how institutional factors, represented by the social profile of childbirth care, can relate to cesarean section rates. Methods: A cross-sectional study based on data from Sistema de Informações sobre Nascidos Vivos (SINASC) for the state of Santa Catarina collected information for each of the six municipalities with the largest number of births from the six macroregional areas. For those municipalities, all of the establishments that had obstetric facilities were considered. A total of 61.278 births took place over 61 selected maternity services. Cesarean prevalence ratios (PR), both crude and adjusted for confounders, were estimated for each one of the individual variables using robust Cox regression. Results: Cesarean births were almost as twice as high in private maternity facilities (89%) when compared to the public ones (45.1%). Giving birth in private hospitals increased by at least 50% the prevalence of caesarean section among primiparae (PR = 1.64), Caucasian (PR = 1.57), women with greater attendance to prenatal care (PR = 1.54), and women having daylight birth (PR = 1.5), when compared with those delivering inside the public sector. Conclusion: Differences in cesarean rates in favor of the private system, among women with better social conditions, amongst which it would be expected a lower obstetric risk, have pointed toward differences in obstetric/medical culture permeability and flexibility on medical judgment concerning clinical criteria for cesarean sections.

Study on the Effects of Total Cost Prospective Payment System on the Consumption of Drugs / 中国药房

OBJECTIVE:To investigate the consumption of drugs after the inplementation of total cost prospective payment sys-tem(PPS),and to provide reference for hospital drug cost control. METHODS:The data of prescriptions collected from 9 hospital during 2007-2014 were divided into group A,B and C according to PPS,and then summarized statistically in respects of increase rate of total consumption sum,consumption sum ratio of major category;the drug cost per time of outpatient department,emergen-cy department and inpatient department were calculated as well as consumption sum ratio of self-paid drugs;the dosage per time of drugs in blood pressure and diabetes prescription were also calculated. RESULTS:The total consumption sum of drug increased slowly after the implementation of total cost PPS;the consumption sum ratio of major category kept stable,while that of anti-infec-tive agent decreased;the emergency drug cost per time achieved a negative growth,and outpatient and inpatient drug cost per time increased slightly. The proportion of self-paid drugs was relatively stable. The dosage per time of drugs in hypertension and diabetes prescriptions was stable,too. CONCLUSIONS:Total cost PPS is useful in controlling the rapid growth of drug costs,and promote the reasonable drug use. The consumption sum of self-paid drugs are well controlled. The increase of drug cost per time in outpa-tient and inpatient should arouse the attention of the relevant departments. In addition,it has no effect on drug dosage for the pa-tients with hypertension and diabetes.

Refinement and Evaluation of Korean Outpatient Groups for Visits with Multiple Procedures and Chemotherapy, and Medical Visit Indicators / 보건행정학회지

BACKGROUND: Issues concerning with the classification accuracy of Korean Outpatient Groups (KOPGs) have been raised by providers and researchers. The KOPG is an outpatient classification system used to measure casemix of outpatient visits and to adjust provider risk in charges by the Health Insurance Review & Assessment Service in managing insurance payments. The objective of this study were to refine KOPGs to improve the classification accuracy and to evaluate the refinement. METHODS: We refined the rules used to classify visits with multiple procedures, newly defined chemotherapy drug groups, and modified the medical visit indicators through reviews of other classification systems, data analyses, and consultations with experts. We assessed the improvement by measuring % of variation in case charges reduced by KOPGs and the refined system, Enhanced KOPGs (EKOPGs). We used claims data submitted by providers to the HIRA during the year 2012 in both refinement and evaluation. RESULTS: EKOPGs explicitly allowed additional payments for multiple procedures with exceptions of packaging of routine ancillary services and consolidation of related significant procedures, and discounts ranging from 30% to 70% were defined in additional payments. Thirteen chemotherapy drug KOPGs were added and medical visit indicators were streamlined to include codes for consultation fees for outpatient visits. The % of variance reduction achieved by EKOPGs was 48% for all patients whereas the figure was 40% for KOPGs, and the improvement was larger in data from tertiary and general hospitals than in data from clinics. CONCLUSION: A significant improvement in the performance of the KOPG was achieved by refining payments for visits with multiple procedures, defining groups for visits with chemotherapy, and revising medical visit indicators.

Early outcome of the Korean Diagnosis-Related Groups payment system for appendectomy

PURPOSE: The implementation of the Korean diagnosis-related groups (DRG) payment system has been recently introduced in selected several diseases including appendectomy in Korea. Here, we report the early outcomes with regard to clinical aspects and medical costs of the Korean DRG system for appendectomies in Seoul Metropolitan Government - Seoul National University Boramae Medical Center throughout comparing before and after introduction of DRG system. METHODS: The DRG system was applied since January 2013 at our institute. After the DRG system, we strategically designed and applied our algorithm for the treatment of probable appendicitis. We reviewed the patients who were treated with a procedure of appendectomy for probable appendicitis between July 2012 and June 2013, divided two groups based on before and after the application of DRG system, and compared clinical outcomes and medical costs. RESULTS: Total 416 patients were included (204 patients vs. 212 patients in the group before vs. after DRG). Shorter hospital stays (2.98 +/- 1.77 days vs. 3.82 +/- 1.84 days, P < 0.001) were found in the group after DRG. Otherwise, there were no significant differences in the perioperative outcomes and medical costs including costs for first hospitalization and operation, costs for follow-up after discharge, frequency of visits of out-patient's clinic or Emergency Department or rehospitalization. CONCLUSION: In the Korean DRG system for appendectomy, there were no significant differences in perioperative outcomes and medical costs, except shorter hospital stay. Further studies should be continued to evaluate the current Korean DRG system for appendectomy and further modifications and supplementations are needed in the future.

Comparative Analysis on Prospective Payment System Based on Diagnosis Related Group System Mode and Project Payment Mode / 中国卫生经济

Objective: To compare the advantages and disadvantages between Prospective Payment System based on Diagnosis Related Group System ( DRGs-PPS) mode and project payment mode. Methods: Historical review method, sampling and comparison are used to compare and analyze DRGs-PPS mode and project payment mode. Results: Through comparative analysis, it is founded that the application of DRGs-PPS mode could make the three wins of government, medical institutions and patients, which has more advantages than project payment mode. Conclusion: DRGs-PPS mode has important influences in controlling the increase of social health expenditure, improving the quality of medical services and standardizing medical behaviors.

American Medicare Experiences and Implications of Inpatient Hospital Payment Reform for China / 中国卫生经济

To discuss background of Medicare hospital payment system reform in the U.S., its legislative and administrative system and the key issues incurred during the design and implementation process, then summarized the experiences and lessons and suggestions were proposed for current provider payment reforms in China.

On the Feasibility of a RUG-III based Payment System for Long-Term Care Facilities in Korea / 간호학회지

PURPOSE: The purpose of this study was to classify the elderly in long-term care facilities using the Resource Utilization Group(RUG-III) and to examine the feasibility of a payment method based on the RUG-III classification system in Korea. METHOD: This study measured resident characteristics using a Resident Assessment Instrument-Minimum Data Set(RAI-MDS) and staff time. Data was collected from 530 elderly residents over sixty, residing in long-term care facilities. Resource use for individual patients was measured by a wage-weighted sum of staff time and the total time spent with the patient by nurses, aides, and physiotherapists. RESULT: The subjects were classified into 4 groups out of 7 major groups. The group of Clinically Complex was the largest (46.3%), and then Reduced Physical Function(27.2%), Behavior Problems (17.0%), and Impaired Cognition (9.4%) followed. Homogeneity of the RUG-III groups was examined by total coefficient of variation of resource use. The results showed homogeneity of resource use within RUG-III groups. Also, the difference in resource use among RUG major groups was statistically significant (p<0.001), and it also showed a hierarchy pattern as resource use increases in the same RUG group with an increase of severity levels(ADL). CONCLUSION: The results of this study showed that the RUG-III classification system differentiates resources provided to elderly in long-term care facilities in Korea.

Changes in Quality of Care for Cesarean Section after Implementation of Diagnosis-Related Groups/Prospective Payment System / 예방의학회지

OBJECTIVES: To determine the impacts of Diagnosis-Related Groups/Prospective Payment System (DRG/PPS) on the quality of care in cases of Cesarean section and to describe the policy implications for the early stabilization of DRG/PPS in Korea. METHODS: Data was collected from the medical records of 380 patients who had undergone Cesarean sections in 40 hospitals participating in the DRG/PPS Demonstration Program since 1999. Cesarean sections were performed in 122 patients of the FFS(Fee-For-Service) group and 258 patients of the DRG/PPS group. Measurements of quality used included essential tests of pre- and post-operation, and the PPI(Physician Performance Index) score. The PPI was developed by two obstetricians. RESULTS: Univariate analysis demonstrated significant differences in PPI scores according to the payment systems. With respect to the mean of PPI scores, a higher score was found in the DRG/PPS group than in the FFS group. However, the adjusted effect did not show significant differences between the FFS group and the DRG/PPS group. CONCLUSION: This study suggested that the problem of poor quality may not be related to the implementation of DRG/PPS in Cesarean section. However, this study did not consider the validity and reliability of the process measurement, and it did not exclude the possibility of data omission in medical records.

An Equality Analysis of Medical Insurance Payment System / 中国医学伦理学

The medical care insurance system has been gradually adopted in Chinese society,whose steady movement is dependent of the benefit balance among all stakeholders of the medical insurance system.Based on Rolles's social justice theory,this article analyzed the equality in the medical insurance payment approaches of prospective payment system and post payment system,pointing out their respective influences on each stakeholder in the medical insurance system.