Evaluation And Analysis On The Implementation Effect Of Total Pre - Payment System In Beijing

Background and Objective:National"12th Five-Year Plan" For Health care reform put forward that China will continue to promote health care reform during 2011 to 2015. And we will strength the coordination around the "health care reform, health system reform and drug circulation reform" to realize "the Breakthrough of Health Reform ". At present, China’s basic medical insurance coverage is 95%. But with the gradual promotion of the reform, the health insurance fund imbalances and excessive growth of health care costs are still serious. According "Opinions on promoting the medical insurance payment reform",we should gradually explore the Prospective payment of total amount money system. Beijing started pilot project of second-tier and third-tier hospitals from 2011 to 2014. It has made some achievements. But in the implementation process, there have been some problems. Through studying their overall operation after implementation of the system, this paper summary the results and problems in the progress.then put forward a general idea and policy recommendations to improve the total prepaid system and the efficiency of the use of insurance funds. Methods:(1) Data analysis:To understand the situation of implementation of the the Prospective payment of total amount money system, including changes in the total cost of the medicine, the health insurance fund of usage and changes in Medicare patient volume and cost of services. At the same time, to understand the effect of the implementation of the system in pilot hospitals. (2) Questionnaires:Analyzes the factors lead to hospital overruns and balances. (3) Expert interviews:Sum up the achievements and deficiencies.Results:With the implementation of the prospective payment of total amount money system, the growth rate of the urban workers’medical insurance total expenses is less than the growth rate of total medicine expenses over the same period. The proportion of patients with medical services account for all the patient of the hospital service quantity is relatively stable and increased year by year. At the same time, Medicare patients’average expense and the proportion of medicine show a downtrend. But the visitor head ratio has crept higher. Through the analysis of the cost overruns and balance, we found the main reasons caused the hospital total prepaid overruns are the increase of the patient number, the increase of the new technology and treatment, the increase of the material procurement costs and increase of the number of critical patients,etc. While some hospitals can achieve the balance is due to the effective control of the use of insurance funds, through the following measures:the quality assessment index of department, the rational use of drugs, and reduction of patient days.Conclusion:Achievement:The rapid rise in health care costs has been effectively controlled. And the average cost of hospitalization and drug proportion has decreased. Improve the management of Department of Medical insurance and hospitals. Grading treatment began to play a role. Deficiencies:The management of Department of Medical insurance is not very meticulous. Asymmetric information is between departments. Hospital management level need to be further strengthened. Decomposition medical treatment still exists. Suggestions:Proper calculate the index. Improve the examination index. Reasonable distribution and use of the fund. Strength communication in departments. Strength the management of second-tier hospitals. Strength the management of Social Security Card. Improve the HIS. Strength the training of policy to the medical managers and staffs.