Game analysis on hospital outpatient payment methods of Chinese basic health insurance based on principle-agent theory / 中华医院管理杂志

As the major means of outpatient payment for basic medical insurance (the insurance for short) relies on fee-for-service, it tends to encourage unreasonable growth of medical expenses. Based on the principal-agent theory, this paper analyzed the principal-agent relationship between the insurance handling agencies and the hospitals designated by the insurance, and constructed a benefit game model of outpatient payment methods and the supporting supervision game model. This practice aims to explore the optimal and balanced benefit of the insurance payment methods and supporting supervision mechanism, and provide decision support for promoting the reform of medical insurance outpatient payment in China. The analysis results of the benefit game model of payment methods showed that a system mixing the post-payment and pre-payment could optimize and maximize the total benefits and interests of all the stakeholders within the system. Specifically, the practice recommended was a mixed payment integrating ambulatory-payment-classification, fee-for-service and global-budget-payment. The analysis of the supporting regulatory game model found that the factors that must be considered to ensure the expected utility of the above mixed payment mode as follows: the gap between the unreasonable income obtained by the hospital by out-of-control charging and the reward obtained by under-control charging, the size of the penalty after the unreasonable income of the hospital was discovered, the size of the regulatory cost and the loss of benefits of the government and the insured group. It is suggested to adopt the mixed payment method mainly based on the ambulatory-payment-classification supported by fee-for-service and global-budget. At the same time, medical insurance agencies can improve their supervision mechanism from such aspects as perfecting penalties, reducing supervision costs, leveraging government administrative power and advocating public supervision.

Profile and inspirations of hospital value-based purchasing of MS-DRG in the United States / 中华医院管理杂志

Pay-for-performance(P4P) is the third stage of payment evolution in the United States. As of 2010, the Centers for Medicare and Medicaid Services launched a series of P4P programs, including hospital value-based purchasing(HVBP) program. This paper introduced the background and eligibility of HVBP in the United States, focusing on the contents and calculation methods of HVBP as references for the reform of payment methods in China.

Research on the Implement Pathway of DRG Payment Reform in Public Hospitals / 中国卫生经济

The reform of medical insurance payment mode was an important lever to regulate medical service behavior and guide the allocation of medical resources.The DRG payment system of China was entering the stage of empirical research and practice testing.Combined with the internal operation mechanism of public hospitals in China,the DRG payment methods of hospitals were divided into preparation period,simulation period and the implementation period.The implementation pathway of implementing DRG payment in public hospitals was discussed from the perspective of hospital information system transformation,settlement process transformation and data simulation test.According to the incentive effect of DRG payment method on hospital cost efficiency and the characteristics of "output" of standardized hospitals,it analyzed the impact of DRG payment method on hospital operation management from the aspects of cost management,performance management and subject development.

Coordination mechanism of medical insurance payment system and salary system reform in public hospitals :An expectancy theory analysis on paid physician behavior / 中国卫生政策研究

The in-depth improvement of medical treatment is particularly important for the integrity, systema-ticity and synergy of the reform. Through the theoretical analysis of physician's incentive expectation, it was found that the doctor's behavior is continuously affected by the three pairs of motivational relationships, and the interrupted or distorted incentive relationship is not conducive to guiding the reasonable service delivery from physicians. In these three pairs of incentive relationship, the two reforms of medical insurance payment system and physician's salary system occupy an important position, and their degree of correlation is extremely high. Only when the two are effectively synergistic can the incentive compatibility" of public medical institutions and physicians be realized to achieve the expected results. The goal of is to make a change in the physician's behavior as expected by the health system in the reform.

Analysis on the influence of single-disease payment method on medical service quality: bladder cancer as an example / 中华医院管理杂志

Objective To analyze the impact of medical service quality after single-disease payment method was in place at a number of tertiary hospitals in Tianjin .Methods Retrospective analysis and satisfaction questionnaire were used to choose 1035 cases of bladder cancer from January 2015 to May 2017 , consisting of 522 cases settled in conventional medical insurance payment prior to the reform , and 513 cases settled in the single-disease payment.300 patients were selected from each type plus 128 doctors, for satisfaction questionnaire survey .Results The single-disease payment method , since in place , had cut back the average days of stay by 1.27 days, per-capita inpatient medical expenses by 1237 yuan, average out-of-pocket payment by 3890 yuan, and the non-payment amount by 11 yuan.Both patients and doctors were more satisfied than before to a different extent , with the difference statistically significant (P<0.05). Conclusions Single-disease payment method can control the cost obviously , thus conducive to the quality of medical services .

"The Practices of ""Hospital Value-Based Purchasing"" Program and Its Implication" / 中国卫生经济

As a mode of pay for performance,hospital value-based purchasing has been become widespread the US.Medicare managed to encourage the service providers to provide medical services with more value and quality.The implementation background,financing,payment mode and performance evaluation of hospital value-based purchasing were briefly introduced.In the payment reform of China,it also needed to focus on the medical service quality,learn from the performance evaluation system,incentive mechanism and multiple measurement,reasonably design the implementation scheme.

Analysis on the Implementation Effect of Medical Insurance Expenditure Prepayment System / 中国卫生经济

Objective:To compare and analyze the changes of\the full implementation of relevant indicators before and after implementing the medical insurance payment in the total prepaid amount in Harbin,evaluate the implementation effects of total prepayment method and propose the reasonable suggestion on better implementation of medical insurance policy.Methods:Using SPSS Software for data collection and conduct descriptive analysis so as to compare the related indicators of hospitalization patients under municipal medical insurance before and after the implementation of medical insurance prepayment system.Results:2 years after the implementation,there were significant changes in the amount of medical insurance,the amount of inpatient care,and the average hospitalization expenses of patients.The overall municipal medical insurance and the average hospitalization expenses were on negative growing.Conclusion:After the implementation of the total amount of prepayment medical system,the control effect with the average cost was significantly,but it also exposed some problems.It needed to have some appropriate adjustments in the policy so as to adapt to the national health care reform in depth and to alleviate the current situation of "difficult and expensive to get medical service".

Practice of hospital cost control by way of diseases payment scoring of global budget in Huaian,Jiangsu province / 中华医院管理杂志

By means of global budget,the disease-specific scoring method was put in place for both settlement and payment in Huaian,Jiangsu province,for the purpose of cost control by the hospitals.This reform consists of total cost accounting,rational performance-based distribution system,multi-approached regulation of medical behaviors,and individual disease management to regulate medical behavior.These efforts aim at aligning with medical insurance payment reform,so as to improve hospital management,operation quality and socio-economic outcomes.Problems found in practice were also reviewed.

Payment Reform of Medical Insurance Payment: Commentary of International and Domestic Research Progress and China's Practice / 中国卫生经济

The reform for medical insurance payment was the important method for standardizing medical service provider behavior,controlling costs and improving efficiency,which was also the important measurement for further improve and implement the reform of drug and health system.Since the new medical reform in 2009,the central and local government had paid more attention on the role of medical insurance payment reform.Local medical departments of different places implemented reform pilots.Through summarizing the foreign and domestic researches around capitation,bundle payment and global payment,the experiences and effectiveness of these pilots were evaluated so as to provide corresponding policy implications.

Investigation on the Payment Methods of 5 kinds of Chronic Diseases in Public Hospitals of Heze / 中国卫生经济

Objective:To investigate the payment methods of 5 kinds of chronic diseases in public hospitals of Heze.Methods:8 383 cases of hypertension,diabetes,coronary heart disease,chronic bronchitis and hepatitis B were enrolled from the Municipal Hospital,the Second People's Hospital,the Third People's Hospital,the City Hospital of Traditional Chinese Medicine and the Infectious Disease Hospital in Heze from January 1,2012 to December 31,2015.The information of medical records and the cost of hospitalization were collected and analyzed.Results:The total hospitalization expense,examination fees and other costs of medicare patients were significantly higher than those of the non-medicare patients(P＜0.05),while the drug expenses were significantly lower than that those of non-medicare patients(P＜0.05).As to the medicare patients,hospitalized expense of male patients was significantly higher than that of female(P＜0.05),hospitalized expense and insurance expense of patients over 45 years old were significantly higher than those of patients under 45 years old(P＜0.05),hospitalized expense and insurance expense of retired patients were significantly higher than those of patients on-the-job(P＜0.05),total expense of urban patients were significantly higher than those of rural patients(P＜0.05).Conclusion:Payment of patients with chronic diseases was in relation with hospitalization expenses,which was also related to the social economic characteristics,but it was worth paying attention to avoiding excessive medical treatment and waste of resources,which needed to take comprehensive measures in combination with social situation.

Practice and Thinking of Scoring Diseases Payment under the Control of Total Budget / 中国药房

OBJECTIVE:To study the implementation of scoring diseases payment under the control of total budget in some ar-eas of China,and provide reference for the further improvement of the payment. METHODS:Based on the operation process of scoring disease payment in the control of toal budget,the specific practices of Huaian,Nanchang,Zhongshan and Taiwan area, were compared. RESULTS:It showed differences in the control and allocation of total budget,the establishment of scoring diseas-es,the setup of adjustment coefficient,the development of balance methods,the complementary mechanism and the monitor exami-nation setting. CONCLUSIONS:Whether to classify the diseases according to diagnosis and treatment methods,how to setup ad-justment coefficient appropriately,how to reimburse the patients in stages and how to strengthen supervision are worthy of further thinking and exploring.

Discussions on the progress and problems of public hospital payment system reforms in China / 中华医院管理杂志

Based on a description of the evolution,main reform practices and effects of public hospital payment system reforms,this paper focused on analyzing the existing problems found in the reforms.Such problems namely include lack of scientific and reasonable design of payment standards,lack of systemic and coordinated system reforms,and failure to fully mobilize the enthusiasm of medical workers to participate in the reforms,as well as other underlying causes.Based on such suggestions were put forward to promote public hospital payment system reforms,as negotiation of the payment standard between purchasers and providers,combined approaches in innovation in payment methods,advancing systemic payment system reform,and establishing a transmission mechanism of incentive to the medical personnel.

Analysis on Mechanism of Over-diagnosis and Over-treatment Problem Formation in Public Hospitals of China / 中国卫生经济

According to the theoretical basis of using 5 gripper models of health system reform and high-value policy designing process, to define the over-diagnosis and over-treatment in the process of basic health care utilization in public hospitals of China, basing on the diagnostic framework of the internal and external environment, to explore the causes herein and discriminate the root, direct and intermediate factors that lead to the problem systematically, and identify the formation mechanism of the problem.

Discussion on Day Surgery Payment Method / 中国卫生经济

Through analyzing domestic medical service payment method and day surgery payment method in USA and Australia, combine the current domestic progress of day surgery and its main prevailing payment to explore the future day surgery payment system in China.

The Comparison of Main Prictice for Per-diem Payment System Reform in China / 中国卫生经济

The per-diem payment is a unit packaged payment used for the medical cost of hospitalization. At present some areas in our country explored the per-diem payment in hospitalization and have received obvious effect. The experiences of different areas carrying out the per-diem payment in our country were compared to find the strengths and weaknesses, and provide references for other areas.