Study on French medical insurance payment policy for innovative medical products paid under DRG / 中国药房

OBJECTIVE To analyze the implementation experience of France’s additional list system for innovative medical products， and to provide reference for China to support medical institutions to use innovative medical products. METHODS Taking France as a case study， using policy analysis method， this paper systematically studied the practice of establishing additional list system to compensate for innovative medical products in France under diagnosis-related group （DRG） payment， including the establishment background， selection procedure and implementation effect. The suggestions were provided on the medical insurance payment methods for innovative medical products in China. RESULTS & CONCLUSIONS The additional list system established a compensation and payment system for innovative medical products with significant clinical efficacy but high treatment cost， covering four stages： application， evaluation， payment and adjustment， which effectively reduced the drug burden on medical institutions， promoted the use of innovative pharmaceutical products by medical institutions， and stimulated the innovation drive of the pharmaceutical industry， but at the same time brought payment pressure to the medical insurance fund. With the rapid spread of our DRG/diagnosis-intervention packet payment reform of China， some regions have also explored the establishment of a compensation and payment mechanism for innovative medical products， but there are still imperfections. We can refer to the implementation experience of the French additional list system and establish an effective compensation and payment system for innovative medical products starting from the establishment of selection criteria， the selection of compensation mode and the implementation of dynamic adjustment.

A comparative study on the difference coefficients of DRG payment in various cities in Zhejiang province / 中华医院管理杂志

In order to compare the setting of difference coefficients in DRG point payment in different cities in Zhejiang province, the implementation rules of DRG point payment issued by 11 cities in Zhejiang province were comprehensively analyzed. It was found that the difference coefficients in different cities could be divided into three categories, including hospital coefficients alone, hospital coefficients and grade coefficients weighted, and weighted by hospital coefficients, grade coefficients, personal burden levels, case mix indexes, and head-to-time ratio. Its setting differences included four aspects: connotation composition, weight distribution, threshold value, and classification of medical institutions. The authors suggested that the adjustment cycle should be set scientifically to dynamically adjust the difference coefficient, and the scientific setting of the difference coefficient should be promoted through provincial coordination.

Research progress and thinking on cost accounting of medical service items based on cost equivalent method / 中华医院管理杂志

Through literature research, this paper analyzed the research progress of medical service project cost accounting based on cost equivalent method. According to the calculation mode of cost equivalent value, this method could be divided into two types, namely, equivalent coefficient method and point method. This paper classified and summarized the application status of cost equivalent method in the cost accounting of medical service projects, analyzed the advantages of cost equivalent method, such as being able to consider a variety of cost drivers, concise accounting process and strong operability, discussed the existing problems of this method, and put forward suggestions for further deepening the application of cost equivalent method and strengthening hospital cost accounting, such as strengthening the summary and case publicity of cost equivalent method, reasonably combining and applying various methods, and scientifically and reasonably developing hospital cost accounting information construction, so as to help build a scientific and accurate cost accounting system for medical service project.

Analysis and enlightenment of medical insurance payment policy for Internet medical services in the United States / 中华医院管理杂志

After recent years′ development, China′s Internet medical service and medical insurance policy system has begun to take shape, but it still needs to be further improved. By combing the connotation and mode of Internet medical services, the evolution of medical insurance payment system and the content of medical insurance payment policy in the United States, the authors put forward that China could further improve the medical insurance payment policy system of Internet medical care, strengthen the multi-point practice management of licensed doctors on the Internet, give full play to the role of commercial insurance in promoting Internet medical care, and rely on information technology means to improve the medical insurance supervision of Internet medical services, then promote the development and management of Internet medical insurance services in China.

Practice and enlightenment of the construction of medical alliances in Guangzhou / 中华医院管理杂志

Construction of medical alliances could help structural adjustment of medical resources, promote the shift of medical and health investment to primary level, improve the overall effectiveness of the medical service system, and better meet the health needs of the people. Guangzhou has established a multi-form and multi-level medical alliance system in accordance with local conditions. According to the distribution characteristics of medical resources in the districts under the jurisdiction of Guangzhou, these districts were divided into areas of controlled development, those of stable development and those of encouraged development. Different strategies were taken for various medical alliances. Advantages of traditional Chinese medicine were given full play in community health management and elderly care services, alliance of traditional Chinese medicine specialists was established to provide residents with continuous medical and health services. An appropriate medical insurance payment system was established to promote the implementation of the hierarchical diagnosis and treatment system. However, there were still such problems as unbalanced distribution of medical resources, insufficient leverage role played by medical insurances, and rooms of improvement in the ability of primary medical services.

Research and Practice of Mobile Payment for Medical Insurance Based on Internet Payment Platforms / 医学信息学杂志

Taking the Maternal and Child Health Care Hospital of Zhenjiang as an example,the paper introduces its mobile medical insurance payment system based on the Internet payment platforms,describes the system architecture and the main functional modules including binding of social security card,diagnosis and treatment service,personal center and so on,and analyzes the existing problems and deficiencies.

The evolution of the Chinese centralized drug procurement and its logical relationship with medical insurance payment / 中国卫生政策研究

In this study, the evolution of the centralized drug procurement policy and the logical relationship between drug procurement policy and medical insurance payment policy were explored by means of policy and literature review.This paper first examined the three stages of the centralized drug procurement policy, and especially analyzed the characteristics and trends of the current centralized bidding of drugs.Focus was put on the relationship of between the centralized drug procurement and medical insurance drug payment were then explored, and the practical feasibility to solve the drug problem with the help of supporting reforms of the above two systems.As a result, the study found that centralized drug bidding procurement has evolved into negotiation and the lowest price linkage procurement method under the price control of the provincial platform and it could also provide the basis for the formation of medical insurance payment standard of generic drugs.But the functions of National Drug negotiations and the Provincial Health Insurance negotiations overlapped.Fortunately, the drug bidding procurement, medical Insurance payment and other related institutional arrangements could promote the separation of pharmacy from medicine which is likely to provide a solution to the issue of unrealistic drug prices with the support of other coordinated sets of reforms.

Discussion on Reconciliation of Medical Insurance Payment in Public Hospitals of Tianjin Based on Total Medical Prepayment / 中国卫生经济

To deal with the current large workload and difficulty of reconciliation for medical insurance expenses in public hospitals,it proposed a institutionalized and normalized reconciliation management process.Tianjin was selected as the object of research.Based on hospital and medical insurance institutions,it analyzed the existing problems and reasons of medical insurance on reconciliation.It proposed a medical insurance debt accounting based,medical settlement information establishment supported,medical insurance reconciliation process centered medical insurance reconciliation management work system to solve the problem of medical insurance reconciliation and promote the safety and integrity of the obligatory right for medical insurance.

Improving the Fiscal Subsidy and Payment to Promote the Supply-Side Reform in Medical Service Field / 中国卫生经济

Based on the describing the effects and restricts of fiscal subsity and medical insurance payment on medical institutions and doctor behavior,the lead of fiscal subsidy and payment was managed as the important key for the supply-side reform in health service field,so as to promote the regression benefits for public hospitals,help to solve the core problems for new medical reform and achieve the main goal of medical service system reform.

The impact of medical insurance payment standard reform on clinical drug use in designated medical institutions:Based on Fujian provincial level,Fuzhou medical insurance insured per-sonnel empirical evidence / 中国卫生政策研究

Objective:To evaluate the influence of medical insurance payment standard reform on clinical drug use in designated medical institution.Methods:The medical expenses and drug consumption data of provincial level and Fuzhou medical insurance management center 3.31 million is included from April to September of 2016 and the same period of last year were statistically analyzed.The annual drug cost,drug use and the payment standard of med-ical insurance analysis were performed according to the annual statistics.Results: Before and after the reform, the proportion of the payment of standard drugs increased from 22.50%to 64.95%.The top 10 outpatient drugs in pub-lic hospitals and non-public hospitals were changed only in serial number,and after the reform,the cost of outpatient service fee was 73.21%and 39.30%respectively.Meanwhile,the variety and amount of drugs changed greatly of top 10 drugs public hospitals.The increase in drug cost of drugs with joint purchasing price difference was higher,and non-public hospitals were relatively stable.Conclusions: As per the findings of this study, Medicare insurance payment standard reform has significantly affected the choice of drug brands and drug use structure.To focus on the medical insurance payment standard of concentrated purchase of drugs combined with the amount of joint procurement of medicines is beneficial to reduce drug prices.The medical insurance payment standard reform combined with com-prehensive reform of medical and health system measures are much more conducive to play a guiding role.

Comprehensive reform of the medical insurance payment practice in Jian'ou city of Fujian province:progress and analysis / 中华医院管理杂志

This paper introduced the comprehensive reform of the medical insurance payment practice, featuring day/bed payment and clinical visits payment, in Jian′ou city of Fujian province. This reform established a new pattern of "two full coverage", i. e. , covering all designated medical institutions and all outpatient/inpatient diseases within the city. Centering on population healthcare, such a payment practice encourages changes of the medical institutions, namely to shift from profit drivers to cost control. It also pushes the designated hospitals to improve their quality of care and service efficiency based on a rational limit of medical expenses. These measures have lessened the financial burden of patients, achieving a win-win outcome.

Comprehensive reform of the medical insurance payment practice in Jian'ou city of Fujian province:progress and analysis / 中华医院管理杂志

This paper introduced the comprehensive reform of the medical insurance payment practice, featuring day/bed payment and clinical visits payment, in Jian′ou city of Fujian province. This reform established a new pattern of "two full coverage", i. e. , covering all designated medical institutions and all outpatient/inpatient diseases within the city. Centering on population healthcare, such a payment practice encourages changes of the medical institutions, namely to shift from profit drivers to cost control. It also pushes the designated hospitals to improve their quality of care and service efficiency based on a rational limit of medical expenses. These measures have lessened the financial burden of patients, achieving a win-win outcome.

Pharmaceutical procurement and reimbursement schedule in Taiwan / 中国卫生政策研究

Object:The paper aims to analyze Taiwanese experience in pharmaceutical procurement, pharma-ceutical benefits and reimbursement schedule, and make references for the Mainland China. Methods:Through read-ing and analyzing the Taiwanese government policy and the literature published to find out the pharmaceutical pro-curement measures, different medicines’ pricing strategy and its reimbursement mode compared with the Mainland China. Results: Hospitals can purchase medicines based on their own needs, and the purchase price was formed through negotiating with providers and buyers. It has been found that Taiwan only controls the medicines reimburse-ment prices. The international reference pricing is adopted for new medicines, and the originators, bioequivalence/bioavailability generic medicines and general generics reimbursement prices are very high at international reference prices, and need to be weakened in order to fit the requirements. Moreover, the medicine quality is one of the stand-ards considered in case of making decisions on the reimbursement prices. In addition, the reimbursement price is as-sociated with procurement price. When the spread is larger than 30%, the government will adjust the reimbursement to fill the gap. Conclusions: Through the system design and adjustment, the Taiwanese Government have set up a better procurement and reimbursement co-ordination in the pharmaceutical segment, and formed the reasonable prices for the case. The Taiwanese experience can be taken as a reference for the mainland China to refine its procurement reforms and reimbursement policy.

A path annlysis on the constraints of physician behavior by medical insurance payment / 中国卫生政策研究

As a rational economic man and agent, in the primary care Physicians not only pursue target in-come, but also pursue the utility of the agent. Different health care payment has different effect on physician, due to imperfect physician agent of the primary health care, the health care payment is difficult to achieve economic neutral. Based on the theory of target income and physician-induced demand, the paper proves that in the primary health care with the third party payment, there should be a prospective component of payment and fees should be lower than mar-ginal cost, which can not only improve the role of agent, but also constraint the physician-induced demand, so as to achieve health care for physician’s behavior constraints.

Integrated account audits management of medical insurance payment / 中华医院管理杂志

Using the enterprise resource planning(ERP)management mode,the paper analyzed the present medical insurance payment audit accounts at public hospitals,and probed into the establishment of an information management platform for medical insurance payment audit accounts in the ERP environment.The purpose is to perfect the management of medical insurance payment audit accounts,increase the efficiency of hospital's working capital,strengthen the quality and efficiency of hospital management.

Practice of the compound medical insurance payment system under a ceiling control in Shenzhen / 中华医院管理杂志

The paper summarized the compound medical insurance payment system under a ceiling control with Shenzhen characteristics.This practice features ceiling control,prepaid at year beginning,multiple payment methods,monthly payment,year-end closing,and reward for surplus.The following measures have been implemented,namely controlling the total amount,compound payment mode,setting up the scientific and reasonable payment standards and establishing a perfect supervision system.This reform has achieved such outcomes as accessibility of the insured people to primary medical insurance,balance for the medical insurance fund,curbing of rapid rise of medical expenses,progress in the policy of first contact in the community health organization,promoting the development of the health system and raising satisfaction among the insured people year by year.