"Discussion on the outcomes of the""Settlement by disease scoring""reform in medical insurance of Yinchuan" / 中华医院管理杂志

An introduction to the background of theSettlement by disease scoringpolicy in Yinchuan,concept and principles of the policy,and the medical insurance payment practice according to this policy.The authors compared the year-end settlement of medical insurance of a tertiary hospital in Yinchuan before the policy came into practice,expense growth per visit for inpatients of medical insurance,ratio of reimbursement,and ratio of complete out-of-pocket payment.These data were analyzed regarding the merits of such a policy and problems incurred,along with recommendations.

Impacts of payment per disease scoring of medical insurance on hospital management and countermeasures / 中华医院管理杂志

Yinchuan city began since January 1,201 5 to implement the“Disease scoring settlement under total budget”for hospitalization cost settlement.The new settlement method impels the hospitals to strengthen internal management,strengthen cost control,implement clinical pathway,strengthen the construction of hospital informationization,and standardize the hospital medical information upload.This paper covered the policy background and hospital internal management requirements,as well as hospital response measures,for reference of government healthcare authorities in the formulation of policy specific measures,and for the hospital’s medical insurance management department to adjust management mode and work flow,in order to better respond to and implement the policy.