The big data diagnosis-intervention packet payment method: experience from Shanghai and Guangzhou / 中华医院管理杂志

Medical insurance payment model is transforming from project-based purchases to service bundle-based strategic purchases. The new form of bundled purchases should found on a scientifically-led design process of such bundles. The core to bundled purchase would be the payment standard, and the key to its success would be process control. Establishment of such a foundation, a core, and a key, would promote the current price standards, and lead service providers to a standardized medical service standard, so as to ensure a precise rewarding system of payment and service. The big data diagnosis-intervention packet(DIP)is able to fulfill mentioned ambitions by integrating insurance payment and supervision into one management. DIP is a full-process payment mode that encompasses pre-service estimation, in-service process control, post-service grading, and resource allocation. It is an innovative practice in line with China′s national conditions for the modern governance of medical security and medical services.

Increasing insurance protection efforts and improving the fairness of health care services: A-nalysis on the convergence mechanism between New Rural Cooperative Medical Scheme and Healthcare Financial Assistance Program / 中国卫生政策研究

The goal of China's health care insurance system is to improve the fairness and accessibility of health care services for low-income people. In the past 10 years of practice, the insurance has made remarkable a-chievements and gained popularity among broad masses of people. With the support of World Bank and UK Depart-ment for International Development, China Rural Health Development Project ( hereinafter referred as Health XI Project) have used the advantages of unique funding, management and human resources to launched a series of pro-ject activities, with the main goal of achieving effective convergence between the New Rural Cooperative Medical Scheme (NRCMS) and Healthcare Financial Assistance Program (HCFAP) in order to explore the assistance system of catastrophic diseases. Some areas have achieved seamless convergence between NRCMS and HCFAP to explore the assis-tance program for catastrophic diseases in the context of confirming and optimizing the management of services covered by the project, especially conducting a series of exploration and practice activities in the aspects of increasing new funding channels to establish theCatastrophic Disease Assistance Fund, strengthening the related supporting regulations, etc. The results show that the utilization of services covered by HCFAP in the project has significantly improved, the protection level of health insurance has greatly improved, and the people satisfaction has significantly increased.