Research On The Strategy Of Medical Insurance Payment Promoting Chronic Disease Prevention And Control Based On Stakeholder Analysis

Objective Chronic diseases seriously threaten the health of residents and bring a heavy burden to medical insurance payment.China ’s medical insurance payment system based on disease protection is not conducive to the prevention and control of chronic diseases.Medical insurance payment should play a supporting role in the prevention and control of chronic diseases.In view of this,this study focuses on the promotion of chronic disease prevention and control by medical insurance payment.By conducting stakeholder analysis,summarizing relevant foreign experience and investigating the medical insurance payment needs and expectations of insured residents for chronic disease prevention and control,this paper puts forward the implementation strategy of medical insurance payment to promote chronic disease prevention and control,in order to provide reference for promoting China ’s medical insurance payment reform and chronic disease prevention and control.Methods By using the stakeholder analysis method and combining with the field survey data,this paper analyzed the specific demands,interest relations and interest correlation degree of various stakeholders in the promotion of chronic disease prevention and control by medical insurance payment,found out the key participants and objects of medical insurance payment to promote chronic disease prevention and control,and discussed the interest coordination path of stakeholders.Through literature review,the experience of foreign medical insurance payment in promoting chronic prevention and control was reviewed to provide experience for China.The questionnaire survey method was used to investigate the insured residents at the grassroots level to understand their needs and expectations for medical insurance payment for chronic disease prevention and control.Based on the above content and combined with the results of field interviews,this paper put forward the strategy of medical insurance payment to promote chronic disease prevention and control in China.Results(1)Stakeholder analysis results : The core stakeholders of medical insurance payment to promote chronic disease prevention and control include medical insurance departments,health administrative departments,primary medical and health institutions,medical staff and insured residents.Based on the analysis results and the interest-driven transmission mechanism,from the perspective of medical insurance payment,the medical insurance department and other core stakeholders should follow the following interest coordination paths : strengthening policy coordination between medical insurance payment and chronic disease prevention and control;reform the medical insurance payment method to promote the improvement of service quality at the grassroots level;improve the enthusiasm and initiative of prevention and control subjects through medical insurance payment;using medical insurance payment to improve the participation and compliance of demand-side chronic disease prevention and control.(2)Analyzed and summarized the practice of medical insurance payment in the United States,Germany,Japan,Australia and Singapore to promote the prevention and control of chronic diseases.The experience that can be used for reference in China includes : incorporating prevention services into medical insurance payment through legislation;implement value-oriented medical insurance payment;establish a medical insurance reward and punishment mechanism based on the prevention and control effect;mobilize the enthusiasm of chronic disease prevention and control service providers.(3)Needs and expectations survey results of insured residents :(1)In terms of chronic disease prevention services,the utilization of prevention services in the elderly population is better than that in the non-elderly population,but medical insurance payment can promote the utilization of prevention services such as health examination,disease screening and ’ preventive treatment of disease ’ in the non-elderly population.(2)In terms of chronic disease diagnosis and treatment services,the elderly are more inclined to use primary medical and health services.The insured residents have higher expectations for reducing the economic burden of chronic diseases such as increasing the proportion of primary drug reimbursement,expanding the scope of drug reimbursement and increasing the limit of drug reimbursement.(3)In terms of family doctor signing services,insured residents have a general willingness to sign paid contracts,and medical insurance payment can effectively promote their willingness to sign contracts.(4)in terms of the differences in the needs of insured residents,there are differences between the two groups in the use of medical insurance payments for online drug purchase,the provision of medical and health ’ double prescriptions ’ for certain diseases,and the content of family doctor contract services.Conclusion The results of stakeholder analysis show that in the process of medical insurance payment promoting chronic disease prevention and control,we must pay attention to the interest demands of core stakeholders.Based on the interest-driven transmission mechanism,from the perspective of medical insurance payment,we should formulate strategies to coordinate the interests of other core stakeholders and drive them to play their respective policies,organizations or resource advantages.Based on the results of stakeholder analysis,combined with foreign experience and the needs of insured residents,China should strengthen the medical security legislation related to the prevention and control of chronic diseases,and improve the policy coordination between the health department and the medical insurance department to ensure the implementation of medical insurance policies related to the prevention and control of chronic diseases.To explore the integration of appropriate chronic disease prevention services into medical insurance payment,carry out value-oriented medical insurance payment reform,and promote the advance of chronic disease prevention and control;through medical insurance payment to support family doctor contract services and encourage insured residents to strengthen self-management,improve the enthusiasm of prevention and control subjects and objects;improve the outpatient service of chronic diseases,strengthen the medication guarantee for patients with chronic diseases,and reduce the economic burden of patients with chronic diseases.