Research On The Implementation Status Of Single-disease Payment System Of Medical Insurance

"Healthy China 2030" Planning Outline proposes to improve the medical insurance management service system,comprehensively promote the reform of medical insurance payment methods,actively promote disease-based payment and per capita payment,form a compound payment method under total budget management,and improve medical insurance agencies Negotiations and risk sharing mechanisms with medical institutions have basically solved the problems of "difficult to see a doctor" and "expensive medical care".At present,my country’s insured persons have accounted for more than 95% of the total number of people,and the situation of universal participation has basically taken shape.However,for many years,the growth rate of medical expenses has been higher than that of my country’s GDP,and the rate of increase is relatively fast.The growth rate of medical insurance fund expenditure is higher than that of income.With the growth rate,the pressure to maintain the stability of the medical insurance fund is increasing,and the reform of medical insurance payment methods is crucial.The single-disease payment system,as a specific implementation method of disease-based payment,has a certain effect on controlling the excessive growth of medical expenses and increasing the utilization rate of medical services.However,the pilot program has not been fully promoted for many years.In response to this situation,this article uses questionnaire surveys and interviews to investigate the implementation status of the single-disease payment system in City Z,analyze the problems encountered in the implementation of the single-disease payment system,explore the causes of the problems,and put forward some countermeasures to promote The single-disease payment system has been implemented smoothly.This research first uses the literature research method to retrieve documents related to single disease payment,medical insurance payment method reform,medical insurance reform,medical insurance,etc.through CNKI,Wanfang,Chaoxing,Pub Med and other databases,and collate and analyze single disease at home and abroad Payment-related research progress,to understand the current status of single-disease payment research,and lay the foundation for further research on the implementation of the single-disease payment system in City Z.At the same time,the relevant government websites such as the National Medical Security Administration and the National Health Commission are collected to collect relevant policies and regulations related to single-disease payment.On this basis,a questionnaire was formulated to investigate the medical staff in City Z.A total of 214 questionnaires were collected.193 valid questionnaires were reviewed,with an effective rate of 90.19%,which provided data support for analyzing the current status of the implementation of the single-disease payment system in City Z.In addition,a semi-structured interview method was used to interview doctors in the clinic.The interviewees selected the single-disease payment system.Since the implementation of the single-disease payment system,the number of reimbursements has increased.Neurology,cardiothoracic surgery,ophthalmology,respiratory medicine,urology,and bone trauma surgery A total of 14 doctors with the above professional titles were interviewed,and the data met the theoretical requirements of saturation.Through the statistical analysis of the survey data,the data shows that in terms of system cognition,medical staff have insufficient knowledge of the single-disease payment system.Among the nurses surveyed,up to 56.25% have only heard of single-disease payment.72.29% of doctors are still in the basic understanding stage of the system;in terms of the impact on medical quality,33.16% of the respondents believe that the single-disease payment system will reduce the effectiveness of treatment,and 36.26% of the respondents believe that the system is effective The treatment effect has no effect;in terms of the impact on the enthusiasm of medical staff,47.15% of the investigators believe that the implementation of the single-disease payment system will reduce the enthusiasm of medical staff.The study found that during the implementation of the single-disease payment system,medical staff were not motivated to participate in the single-disease payment system,the applicability of the single-disease payment system was insufficient,and the payment standards established by the system were low.The implementation of the system would reduce the quality of medical services The risk of the country’s financial crisis,and the incomplete exit mechanism.In response to the above problems,this article uses the theory of public goods and the two-factor theory combined with the actual situation,from the perspectives of the implementation of the single-disease payment system,the selection of the disease,the formulation of payment standards,the implementation requirements,and the withdrawal mechanism,and the implementation process of the single-disease payment Cause analysis of the problems encountered in the process.In the end,this article proposes the following five countermeasures for the problems in the implementation of the single-disease payment system in City Z: 1.Increase the publicity of the single-disease payment system;2.Regulate the medical behavior of medical staff by formulating corresponding clinical pathways;3.Establish an incentive mechanism to increase the enthusiasm of medical staff to participate;fourthly,improve the withdrawal mechanism of the single-disease payment system;fifthly,strengthen the supervision of the implementation of the single-disease payment system.