Research On The Evaluation Of The Reform Effect Of Medical Insurance Payment Methods In Xuzhou City

The phenomenon of difficult and expensive medical treatment caused by the rapid growth of medical expenses has become an important problem that needs to be solved globally.All countries are actively exploring how to solve the increasingly high medical expenses.With the growth of China’s population and the current situation of the development of medical security,the current medical insurance payment methods in China are basically based on project charges,and the drawbacks are increasingly obvious.The reform of medical insurance payment methods has become urgent.In order to increase income,some medical institutions have caused indiscriminate prescribing,examination and other medical behaviors,which not only wastes medical resources,but also increases the medical expenses of patients,resulting in the excess of medical insurance fund expenditure.Therefore,the General Office of the State Council in 2017 clearly requires to promote the reform of the medical insurance payment method,and encourages medical institutions to implement the payment method of DRGs S.The original intention of the launch and implementation of DRGs is to make the medical insurance fund more scientific and change the current situation of excessive increase in medical expenses.At present,although the implementation of DRGs can effectively alleviate the pressure of medical insurance funds to a certain extent,it will also bring a series of problems.The specific background of the DRGs payment mode reform,through the analysis of relevant data,is to clarify the local implementation of the payment mode,find out the problems in the reform process,and give corresponding corrective measures based on this.This paper starts from the following parts.The second part combs the current situation of Xuzhou’s medical security development,the process and content of DRGs implementation,and compares the current situation of the implementation of DRGs reform in hospitals A and B.The third part focuses on the analysis of the implementation effect of DRGs in hospitals A and B,selects four groups of diseases,mainly studies the changes of the total medical expenses and average hospitalization days of the four groups of diseases before and after the implementation of DRGs,and understands the views and perceptions of each department on DRGs reform.The fourth part analyzes the advantages and disadvantages of the existing payment mode reform,aiming to explain why Xuzhou should implement the DRGs reform.At the same time,it selects two advanced pilot cities in China to introduce their experience,hoping that Xuzhou can learn from it and better promote the DRGs reform.The fifth part is about the problems existing in the reform of medical insurance payment mode in Xuzhou City.It analyzes the problems existing in the DRGs reform in Xuzhou City from the common problems and commonalities existing in the reform of DRGs payment mode in hospitals A and B.After in-depth analysis,due to the characteristics and management mode of DRGs itself,hospitals A and B have the following problems in the process of DRGs reform:(1)government collaborative governance is not fully in place;(2)Medical institutions lack the concept of refined management;(3)Difficulty in medical insurance supervision;(4)The information technology is immature,and the professional and technical personnel are lacking.In the sixth part,aiming at the above problems,this paper puts forward corresponding suggestions from multiple perspectives:(1)improve the coordination mechanism among the multiple governance entities;(2)Strengthen the fine management of medical institutions;(3)Improve the construction of information system;(4)Establish a sound regulatory mechanism.