Study On The Influence Of Payment Mode On Prevention And Treatment Efforts Of Subjects Related To Chronic Diseases

With the arrival of the aging era in China,the morbidity and mortality of patients with chronic diseases are on the rise.The cost of treating chronic diseases has brought a heavy burden on patients and society.Chronic diseases are characterized by long duration and difficult to cure.Hospitals and relevant departments have tried various methods to solve the problem of rising costs and low quality of care for patients with chronic diseases,among which changing the payment mode of medical is considered to be a more effective way,and the rapid development of medical association in China provides an opportunity for the reform of the payment modes of medical.The medical association is composed of a community hospital and a tertiary hospital.Therefore,it is necessary to explore how the payment modes influence the prevention efforts of patients,the prevention efforts of community hospital and the treatment efforts of tertiary hospital and how do different types of medical association choose the optimal payment mode.Also,we need to study how to promote the division of labor and cooperation among the community hospital,the tertiary hospital and patients.The influence of different payment modes on the prevention and treatment efforts of the subjects related to chronic diseases was analyzed under the compact,loose and semicompact of medical association.Through the construction of relevant models,combined with analysis and simulation analysis,some management implications of the following three different types of medical association in choosing payment modes for chronic diseases were obtained.Patients with chronic diseases can choose to go to a compact medical association consisted of a community hospital and a tertiary hospital for prevention and treatment according to the bundled payment,or go to a tertiary hospital outside the medical association for treatment according to payment by service item.To analyze the incentive influence of bundled payment on hospitals,the optimal decision-making model of relevant subjects was established.The prevention efforts of community hospital and the treatment efforts of tertiary hospital were compared under different circumstances.Results show that when the marginal rate of return of compact medical association is high,the bundled payment can effectively improve the prevention efforts of community hospital and the treatment efforts of tertiary hospital outside the medical association.Reducing the marginal rate of return of compact medical association will help to guide patients to choose the tertiary hospital in the compact medical association for treatment.In the loose medical association,chronic diseases patients are divided into mild chronic diseases patients and severe chronic diseases patients,among which mild patients are treated by community hospital.If the community hospital fails to prevent the mild patients,patients will be transferred from the community hospital to the tertiary hospital for treatment.Mild patients whose prevention failed lined up for treatment with severe patients who were transferred directly to the tertiary hospital.To analyze prevention efforts and treatment efforts under payment by diagnosis-related groups,the optimal decision models of each participant are established.The prevention efforts of community hospital and treatment efforts of tertiary hospital under different payment modes and centralized decision-making of medical association making were compared.Results show that when the fees charged by different types of patients are larger and the ratio of the utility of the community hospital to the total utility of patients in the treatment stage is relatively small,the prevention efforts of the community hospital and the treatment efforts of tertiary hospital under payment by payment by diagnosis-related groups can reach the degree of optimal prevention efforts of community hospital and optimal treatment efforts of tertiary hospital under the centralized decision-making medical association and social total utility.In the semi-compact medical association,the health status of patient is affected by the patient’s self-prevention efforts and the prevention efforts of community hospital at the stage of prevention.To study the influence of payment by service item,total payment and mixed payment on the prevention and treatment efforts of patients with chronic diseases and semi-compact medical association.Optimization models were established with the aim of maximizing the patient utility and the total social utility.The influence of the hybrid proportion coefficient on the self-prevention efforts of patient,the prevention efforts of community hospital,and the treatment efforts of tertiary hospital were analyzed.The equilibrium solutions of the self-prevention efforts of patients,the prevention efforts of community hospital,and the treatment efforts of tertiary hospital under three payment modes and the maximum of total social utility were calculated.The total social utility values of the three payment modes were compared.Results show that the self-prevention efforts of patient,the prevention efforts of community hospital,and the total social utility are maximum under the hybrid payment mode.Hybrid payment helps to motivate the prevention efforts by patients,the prevention efforts by community hospital and the treatment efforts by tertiary hospital,and maximizes total social utility.In the semi-compact medical association,the health status of patient is affected by the patient’s self-prevention efforts and the treatment efforts of tertiary hospital at the stage of recovery.To study the influence of payment by service item,total payment and pay for performance on the success rate of chronic diseases prevention and treatment,the benefits of semi-compact medical association and total cost of medical institutions,so the medical insurance institution chooses the payment mode that is most suitable for the prevention and treatment of chronic diseases in the semi-compact medical association.Results show that when the punishment amount of patients after treatment failure is low,the treatment success rate and the benefits of semi-compact medical association of bundled payment are higher than that of pay for performance,the cost of medical institutions according to bundled payment is lower than that of pay for performance.When the amount of punishment after treatment failure is high,the success rate of treatment and the benefits of semi-compact medical association of bundled payment are lower than that by pay for performance,the cost of medical institutions according to bundled payment is higher than that pay for performance.By studying the decision-making problems of three different types of medical association,it will help to better understand the payment for patient prevention efforts,community hospital prevention efforts and tertiary hospital treatment efforts.Different payment modes how to promote the division of labor and cooperation among the community hospital,the tertiary hospital.By comparing the relevant indicators under different payment modes,it can provide reference for medical insurance institutions to choose appropriate payment modes under different conditions,and provide theoretical basis and application value for the design of prevention incentive policies.