Research On The Problems And Suggestions Of The Conduction Of The Policy Of Diagnosis Related Groups Of Tianjin Medical Insurance Department

The 19 th National Congress of the Communist Party of China and the Fourth Plenary Session of the 19 th Central Committee of the CPC highlight the importance of deepening the reform movement of the national medical insurance.In 20 th December,2018,the national healthcare security bureau selected 30 pilot cities to prepare the conduction of diagnosis related groups settlement(DRGs)method,aiming at standardizing the business running of medical institution,controlling the costs and expenses of being hospitalized and improving the quality of medical and healthcare service.As one of the pilot reform movement cities,city Tianjin has already conducted the DRGs settlement method in 2012.Through the research on the public policy of diagnosis related groups settlement method of Tianjin medical care department,the author manages to find problems of the policy and measures to give suggestions on enhancing the conduction of the policy.According to the theory of public policy conduction,the author uses the system model to analyze the relationship of medical insurance with medical institution,medical funds and patient.Combined the work of Tianjin medical insurance funds management department with the investigation of medical institutions and patient,the author finds out the problems of incomplete policy system,small range of catalog,lower payment of medical funds and nonstandard business running of medical institution.In case of fulfilling the purpose of the policy,which means the controlling of costs and expanses of being hospitalized and improving the service of being hospitalized,the Tianjin medical insurance department needs to popularize the policy among citizens,enlarge the range of catalog,standardize the business running of medical institutions and prevent the behavior of the fraud of the medical funds in order to proving the policy conduction.This research makes a creation of analyzing the diagnosis related groups settlement method in a local city of Tianjin,enables the Tianjin medical insurance department to improve the efficiency of using medical funds,form the institution of controlling costs and expenses,and decrease the amount of self-payment of patient when they are being hospitalized.Next step,the Tianjin medical insurance department should prepare the work of diagnosis related groups settlement method for the sake of deepening the reform movement of medical insurance.