Research On Payment Mechanism And Optimization Path On Medical Insurance In Compact Medical Union

With the deepening of the reform of medical security system,it is the key to accelerate the reform of medical insurance payment mechanism in view of the existing practical problems in China,such as the supervision of medical insurance fund,excessive medical treatment in medical institutions and fine management of medical insurance operation.Medical insurance payment mechanism is an important link of medical security system,which links the interests of the insured,medical insurance institutions and medical institutions.In this context,encouraging the formation of close regional medical association has become an important exploration to establish a more efficient and equitable medical insurance payment mechanism.From the point of view of the practical effect,the compact medical alliance in China effectively reduces the medical cost of patients in the region,and creates opportunities for patients to obtain high-quality medical resources.The members of the medical alliance develop together in the competition and form a relatively complete ecological system.The medical insurance payment mechanism plays a positive role as a lever to leverage the cooperation among members of the medical union.Based on the perspective of the sustainable development of the close medical alliance,this paper explored the mechanism of medical insurance payment playing a role in the close medical alliance by sorting out the past experience and problems,and looked for ways to build and improve the medical insurance payment mechanism of the close medical alliance,so as to provide ideas for the efficient and sustainable development of the close medical alliance.Firstly,this paper reviews the relevant literature of medical union and medical insurance payment mechanism,and summarizes the development history and main contents of medical insurance payment of close medical union.Secondly,through sorting out the operating experience of the medical insurance payment of the close medical union in typical areas,three major problems of the medical insurance payment mechanism of the close medical union in China are summarized: the unscientific setting of the total budget system,the insufficiency of systematic medical insurance payment reform and the unsmooth two-way medical treatment channel;Then,based on the analysis of new structural economics perspective,to close couplet of medical health care payment mechanism of endowment structure and the transformation direction is analyzed,using the theory of mechanism design theory and the internal control goal,the idea of the couplet of medical health care payment mechanism and architecture were analyzed,and put forward the healthy and sustainable,fair and efficient three basic principles.With the focus on the reform of the medical insurance payment methods,health care performance management control and the grading system three missions,via the interaction between the elements of couplet of medical and contact,to close couplet of medical coverage pay dual goal: to seek improvement in stability,health care system are to synergy in the domain of medical health service efficiency;Finally,on the basis of the above research,it is proposed that the optimization path of medical insurance payment mechanism of close medical alliance lies in unimpeded cooperation channel of medical insurance payment scope,standard and mode,supporting performance management,hospital management and other contents,and striving to explore a payment mechanism of medical alliance that is suitable and supports the development of regional medical and health undertakings.Specifically,the four measures include exploring the hybrid medical insurance payment mode under the total budget,improving the orderly close medical alliance cooperation system,unblocked regional medical information platform and encouraging social organizations in the medical industry to participate in the regular supervision.