Research On The Reform Of Payment Methods Of Basic Medical Insurance For Urban And Rural Residents In Chengdu

The social medical insurance system is an important part of the social security system.It has the important role of protecting the health of workers,promoting production progress and economic development;mutual aid and mutual assistance,promoting social progress;and maintaining social stability.China has basically established a comprehensive coverage of the basic medical insurance system,and the coverage of medical insurance has further improved.However,the development of China’s medical insurance system still faces rising medical costs,and the primary medical institutions are not perfect,inducing demand,and over-medical."Difficult to see a doctor" and "expensive medical treatment" have caused a heavy burden on patients and their families,seriously affecting the improvement of people’s health.At the same time,the contradiction between the supply and demand sides of medical insurance brings difficulties to the implementation of the system of medical insurance institutions.The continuous increase in medical expenses has brought tremendous pressure on the balance of income and expenditure of medical insurance funds,affecting the sustainable development of medical insurance funds.Rational allocation of medical resources,curbing the excessive growth of medical expenses,balancing the relationship between doctors,patients and insurance is a problem that experts have been paying attention to,and it is also a world problem.Many countries or cities have actively carried out reforms on control fees based on their own circumstances.Practice has shown that the reform of payment methods has a good effect of controlling fees.The payment method refers to the way in which the medical insurance agency pays the fee to the designated medical institution that provides medical services to the patient on behalf of the insured patient.The payment method has a significant effect on the reform of the control fee,which has the balance of the fund’s revenue and expenditure,maintains the stable development of the medical insurance system,and balances the relationship between doctors,patients,and insurance.China has always regarded the reform of payment methods as the core link of medical reform,and actively explored it.It is hoped that the reform of medical insurance payment will be the entry point for “new medical reform”.In 2011,the "Opinions on Further Promoting the Reform of Medical Insurance Payment Methods" to deepen the overall deployment of the medical and health system reform,and put forward higher requirements for the reform of medical insurance payment methods.In 2013,the "Decision of the Central Committee of the Communist Party of China on Comprehensively Deepening the Reform of Some Major Issues" pointed out that it is of great practical significance to reform the payment method of medical insurance,improve the universal medical insurance system,comprehensively deepen the reform of the medical and health system,and promote the reform and innovation of social undertakings.In 2017,the "Guiding Opinions on Further Deepening the Reform of Basic Medical Insurance Payment Methods",proposing that the pay by disease is the focus of future payment method reform,and stipulates further refined and standardized disease classification.Chengdu is also actively pursuing the reform of medical insurance payment methods.From May 1st,2011,the city’s urban workers’ basic medical insurance insured 10 diseases prescribed pay by disease.Since 2013,with the principle of “monthly control,quarterly assessment,over-spending,and surplus incentives”,total payment control has been implemented in all designated medical institutions in Chengdu.Actively explore the promotion of mental illness Pay per bed day,DRGs(according to the disease diagnosis related group payment method)promotion pilot work.The reform of payment methods in Chengdu continues.What is the status of its operation and control fees? What are the difficulties in the reform? How to further optimize the payment method of Chengdu medical insurance,better play the role of basic medical insurance,further reduce the medical burden of patients,improve the efficiency of medical insurance funds,and balance the relationship between doctors,patients and insurance will be the focus of this paper.This paper analyzes the background,process and effect of the reform of the basic medical insurance payment method for urban and rural residents in Chengdu.The factors affecting the average hospitalization expenses are analyzed in detail.The role of hospitals in controlling medical expenses is to explore the problems existing in the basic medical insurance payment methods of urban and rural residents in Chengdu and the direction of future optimization.Based on the actual situation of Chengdu and drawing on international and domestic experience,the corresponding optimization suggestions are put forward.The full text has six main parts:The first chapter is the introduction.It introduces the background and significance of the topic of this article by introducing the role of the medical insurance system and the significance of the reform of medical insurance payment methods.Explain the purpose and content of the research,the ideas,methods,and possible innovations and deficiencies.Through the literature review,the research status of the reform of medical insurance payment methods at home and abroad is explained.It is an international problem to clarify the unreasonable growth of medical expenses.The reform of medical insurance payment methods has a good effect on the control fees.The second chapter introduces the core concepts and experience of domestic and international medical insurance payment methods.The comparison introduces the main payment methods and their advantages and disadvantages.The main payment methods are fee-for-service,total payment control,Pay per bed day,and pay by disease.It shows that the rapid increase of medical expenses in China is a difficult problem at present,and the analysis of the cost control measures in the context of rising medical expenses shows that the reform of payment methods is an effective method.The paper compares and analyzes the experience of domestic and foreign payment method reform.The foreign countries mainly introduce the United States,Germany and the United Kingdom.They elaborate on the pricing process of Ms-DRGs in the United States,the reform process of German payment methods and the British “gatekeeper” system.The domestic part elaborates on the earlier and representative reform of Shanghai.Summarize the experience of payment methods reform in relevant countries and regions,and explain the general path of payment mode reform.The third chapter explains the influencing factors of medical expenses and the mechanism of controlling medical expenses by means of payment.By collecting detailed data of hospitalization medical expenses of urban and rural residents in Chengdu from 2014 to 2016,the main factors affecting hospitalization medical expenses were analyzed.Because there is no malignant tumor in Chengdu at present,this paper chooses the lung malignant tumors which are the most common malignant tumors in urban and rural residents of Chengdu,and makes a detailed analysis to illustrate the factors that need to be considered in the classification of diseases and the main factors affecting the cost.This paper analyses the effect of the reform of medical insurance payment mode on medical institutions,and holds that medical institutions are the key link in the reform of payment mode.Using the knowledge of economics,this paper illustrates the relationship between different payment methods and medical expense control.The fourth chapter is the focus of this paper.It traces the history of the reform of the basic medical insurance payment method for urban and rural residents in Chengdu and the better part of the current work.In 2011,Chengdu began to pay for the disease.In 2013,the total payment control was carried out.In the process of reform,Chengdu established a negotiation mechanism for drugs and medical service fees,improved the assessment mechanism in a timely manner,and optimized the medical insurance supervision system.Through the specific data of medical insurance reimbursement in Chengdu,the changes in medical expenses since the reform of payment methods were explained.It is believed that the reform of payment methods controls the continuous increase of some medical expenses,promotes the efficiency of medical services,and regulates medical behavior.The fifth chapter summarizes the experience of reforming the payment method of medical insurance at home and abroad.The paper analyzes the reform of payment methods in typical countries and cities at home and abroad.The foreign countries mainly introduce the United States,Germany and the United Kingdom.They elaborate on the pricing process of Ms-DRGs in the United States,the reform process of German payment methods and the British “gatekeeper” system.The domestic part elaborates on the earlier reform and representative reform of Shanghai’s payment methods,and summarizes the experience of payment methods reform in relevant countries and regions.The sixth chapter proposes to improve the reform of payment methods for medical insurance in Chengdu.Strengthen the control measures to ensure the balance of funds and funds;improve the incentive and restraint mechanism and supervision mechanism to improve the enthusiasm of hospitals and doctors;for the total budget,it is necessary to optimize the process of total indicator development,and recommend the measurement of the number of services based on the measurement of costs.Other indicators of quality.The supporting assessment mechanism should consider the real-time patient flow problem;gradually promote DRGs according to the method of disease payment,gradually expand the scope of the pilot,update the disease catalogue,and strengthen the role of the hospital in the reform.The improvement of graded diagnosis and Patient transfer.