ABSTRACT
Pilot areas have achieved initial success in capitation reform. On the other hand, challenges remain unsolved in terms of practical pathways, change of national medical insurance management system, related measures, incentives and allocative mechanism for implement of the reform. With the concerning on progress, practice, effects and challenges of typical areas, this article established an institutional framework. On such basis, we propose to design and refine a scheme in terms of 5 aspects, namely strengthening the basic medical care packages′financing, setting contents and standard of the basic medical care packages rationally, establishing effective evaluation system and formulating supporting measures.
ABSTRACT
Objective To analyze the main practices of capitation payment system reform in the case areas and put forward enlightenments and suggestions in this regard. Methods The implementation practices of the case areas were summarized, and descriptive statistical analysis was carried out on the implementation effects. Results By analyzing the effectiveness of the case areas′reform, it was found that the case areas are curbing the excessive growth of medical expenses (for example, outpatient fees per visit of Dingyuan county-level hospitals decreased from 245.11 yuan in 2015 to 218.40 yuan in 2017), increasing the actual compensation ratio of residents ( for example, the actual compensation ratio of Funan increased from 59.80% in 2015 to 63.28% in 2017), forming a medical treatment pattern within the county (for example, out-of-county compensation ratio in Dingyuan decreased from 37.38% in 2015 to 31.13% in 2017), achieving double-way referrals (for example, the number of referrals to superior hospitals of Jimo increased from 98 in 2015 to 328 in 2017), improving the subsidence of quality services, and controlling the risks of medical insurance funds. Conclusions At present, the reform of the case areas has been implemented steadily and achieved results. It is recommended to further improve such aspects as reform coordination, insurance standard setting, incentive mechanism establishment, and leadership to ensure the reform progress.
ABSTRACT
Through the investigation of the single disease policy and the local actual situation in many regions of the country, it analyzed the practical problems faced by Chinese medical institutions in the implementation of single disease payment policy. The necessity and urgency of the national unified single disease payment policy were put forward, and the system of standard quota payment for single disease standard was preferred, supporting patients to pay extra fees for differential medical services, standardize the accounting policy of single disease payment.
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Objective To study doctor-patient interest demands satisfaction and its influencing factors of the payment system reform of the new rural cooperative medical care scheme to provide reference for the reform. Methods Cross-sectional survey was conducted from September 2016 to February 2017. Multi-stage stratified random sampling was used in six counties of three provinces in the eastern, middle and western regions of China, and mathematical statistics was applied to analyze the data. Results The doctor-patient overall interest demands satisfaction was high, but the satisfaction was lower both with the income and ability improvement of medical staff and with the benefits of farmers. The influencing factors of the satisfaction of managers in medical institutions included the type of payment, educational level and work unit (P＜0.05). The influencing factors of medical staff's satisfaction included the type of payment, work unit, and working years among others(P＜0.05). The influencing factors of farmers'satisfaction included the type of payment and the average annual income, etc(P＜0.05). Conclusions The core interest demands of both doctors and patients should be valued to enhance their satisfaction. Diseases related groups should be promoted and applied scientifically, and appropriately integrated with other methods of payment. Both doctors and patients'understanding of the payment reform should be improved by propaganda and training, to get their support and cooperation.
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Objective To study the participating farmers'interest demands for NRCMs in order to provide basis for the payment system reform based on the demand side perspective. Methods A cross-sectional study was conducted from September 2016 to February 2017. Multi-stage stratified random sampling was conducted in six counties of three provinces in the eastern, middle and western regions of China. Mathematical statistics analysis was conducted to clarify the interest demands and influencing factors of the participating farmers. Results The interests claims of the 1 452 participating farmers were to improve service quality, to reduce the economic burden of disease, and to standardize the management. The medians found were 4.00, 4.00 and 3.63 respectively. Relative to the flat rate, the DRGs raised higher requirements for standardized medical behaviors offered by the medical workers. Furthermore, it called for effective medical quality supervision, rigorous control of medical costs and highly scientific and standardized management. The differences were statistically significant ( P ＜0.05 ). Conclusions The diversity of participating farmers'interest demands deserves due attention, the payment methods combination should fit local needs, the interests demands expression channel of the participants should be expanded, and the demand side deserves a due role in supervision of the funds.
ABSTRACT
The establishment of negotiation and consultation mechanism between medical insurance management agency and medical institution,could proceed the development of provider payment system reforms.This paper discussed the policy basis and the basic principle of negotiation and consultation in provider payment system reforms,and the subject,level and model,content,the carrying out and so on.
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With the full coverage of China 's basic medical insurance, medical costs showed a rapid growth trend. It is becoming more and more important to control the cost of medical treatment. Strengthening the control of medical insurance providers is the experience of international health insurance management and an important direction of China's basic medical insurance system reform. Many areas explore the reform of basic medical insurance payment actively and accumulated a lot of typical experience. When exploring the reform of basic medical insurance payment, the practical experience proposes that we should avoid the shortcomings of the post-payment system and prospective payment system, and push a combination of a variety of payment methods such as the capitation, the Pay per bed day, the DRGs etc. , and the promotion of comprehensive reform of public hospitals to establish a classification diag-nosis and treatment.
ABSTRACT
Reform of the medical service payment system plays a key role in deepening the ongoing health reform.China will launch in a large scale the trials of the payment system for its betterment.The author probed deeply into the current compensation mechanism of public hospitals,as well as the inherent and theoretical roots of the negative outcomes resulting from the item-based payment system.On such basis,the paper discussed the nature of the public hospitals,and the theoretical basis for public hospitals' compensation system.In addition,the author discussed the reform principles and key points for reforming the payment system amid the ongoing health reform,proposing to link this reform with resolving major setbacks of the compensation mechanism of public hospitals.Objectives for the medical service payment system reform are advocated as follows: Cost control,management enhancement,mechanism shift,and win-win,which aim to deep reforms of the public hospitals.