Classification Reform Of Medical Service Price In China

The price of medical service is the monetary manifestation of the value of medical service.It is an important economic lever to adjust the total amount and structure of medical service,straighten out the doctor-patient relationship and optimize the allocation of medical resources.Since the founding of the People’s Republic of China,the reform in the field of medical service has followed the logic of incremental reform,especially since the beginning of this century,with the reform of medical service price as the core and the overall reform of traction medical service becoming an important core.In 2016,the central government issued the "Opinions on Promoting the Reform of Medical Service Price",marking a new stage of China’s medical service price reform.Compared with ordinary commodities,medical services have special properties.Health economics points out that medical service is a special service with public,quasi-public and private.It is precisely because medical service is different from ordinary commodities that the reform is full of complexity and difficulties.In particular,the market-oriented medical service reform started in the mid-1980 s has come to a temporary conclusion that it is "generally unsuccessful".The most direct manifestation of the failure of reform is the low use efficiency of medical and health resources,the unfair allocation of resources,the unbalanced development between urban and rural areas,between regions and between links,and the long-standing phenomenon of "difficult to see a doctor" and "expensive to see a doctor",which arouses strong reactions from the people.The focus of the problem is reflected in the price reform of medical services.The price relation of medical service is not reasonable,the classification management is not thorough,the price supervision mechanism is not perfect,the reform coordination is not complete.In particular,there are still problems such as insufficient understanding of the importance of the basic nature of medical service,insufficient understanding of the system of medical service price reform and insufficient understanding of the complexity of medical service price reform.The thought of Chinese medical service price classification reform has always existed,but it will push forward the reform according to the nature of the medical institution.The reform of medical service price has entered the new stage of deep water area,so it is urgent to take a new perspective on the theoretical and practical problems.Taking the "Opinions on Promoting the Price Reform of Medical Service" as the cornerstone,this paper proposes that the price reform of medical service should not be classified based on the attributes of medical institutions,but on the differences of the nature of medical service products.This paper divides the medical service products into three types: basic medical services,competitive medical services and special medical services.It also analyzes the formation mechanism of basic medical service price by incentive regulation theory,competitive market theory,and special medical service negotiation bidding price by game theory.The logical arrangement and main contents of each chapter are as follows:First,it analyzes the background and significance of Chinese price reform of medical service.It reviews and reviews the literature on the nature of medical service,the market characteristics of medical service,the pricing of medical service,the market failure of medical service,the regulation of medical service price and the reform of Chinese medical service price,and then defines the connotation of the core concepts such as price mechanism of medical service and supervision of medical service.Based on the Opinions on Promoting the Reform of Medical Service Price in 2016,the research ideas and framework of this paper are put forward,and the idea of promoting the reform of medical service price in a holistic,systematic and classified way is emphasized.The second is to sort out the theories related to medical service price.Existing medical service price research has shown that guiding medical service price theory includes Marxist service price theory,people-centered development theory,monopoly competition theory,government regulation theory,competition theory under the regulation framework,price reform theory,and so on.These theories provide corresponding theoretical guidance for medical service price reform.The third is the analysis of the medical service price reform process and the effect evaluation.The paper divides medical service price reform into four stages and analyzes the results of each stage based on the policy direction and characteristics of reform in different time periods,and summarizes the main issues facing the reform of medical service price.The fourth is the analysis of Chinese medical service market and price classification reform.This part of the study lays a foundation for the classified study of price reform in Chapter 5,Chapter 6 and Chapter 7,and forms the total score structure of this paper.Firstly,the medical service market is analyzed,and the supply of medical services is analyzed according to the number of medical institutions,hospitals,public and private hospitals,various types of health personnel,and the number of health personnel per thousand population from 2012 to 2020.This paper analyzed the market demand of Chinese medical services based on the number of service population in medical and health institutions,the diagnoses and treatment of public and private hospitals from 2012-2019,the medical balance of new rural cooperative fund,the balance of staff and staff basic medical insurance fund,and the balance of urban and rural residents basic medical insurance fund.Secondly,it compares the price norms of medical service items in 2001 and 2012,and points out the innovation of the price norms of medical service items in 2012.At the same time,the factors affecting the price of medical service are summarized.Thirdly,according to the Opinions on Promoting the Reform of Medical Service Price in 2016,the general requirements,principles and objectives of the reform of medical service price are analyzed.This paper analyzes the logic of price classification reform of medical services,puts forward that the transformation of hospital classification to product classification of medical services is the inevitable choice of the reform of medical services,and designs the conception of the price reform of basic medical services,competitive medical services and special medical services.Fifth,it has analyzed the price reform of basic medical service.This paper introduces the international background and theoretical connotation of basic medical service,analyzes the evolution of the policy and theoretical understanding of basic medical service,and analyzes the development of Chinese basic medical service by using indicators such as the growth of per capita health cost,the expenditure structure of health cost,the number of beds of medical institutions,the number of people covered by basic hospitals,the supply and demand of rural basic medical care.This paper analyzes the current price of basic medical service.Consumers are at the disadvantage of information and can not enjoy the optimal service.The traditional price regulation is difficult to solve the multiple contradictions,realize the balance of interests,and restrict the development efficiency of the medical service industry.Based on this,this paper puts forward the incentive regulation theory and analyzes the compatibility of incentive regulation and price reform of basic medical service,and points out that the reform of basic medical service price includes pricing and price adjustment of service products.The pricing should reflect not only the guided price of the government,but also the price provided by the basic medical service market.In the pricing part,the price ceiling regulation theory of incentive regulation is used to give medical institutions part of the free pricing right and form the incentive price formation mechanism of medical services.The price adjustment reflects the dynamic price of basic medical services and the change of government-guided price with the development of economic society and the evolution of disease types.In terms of policy support for the price of basic medical services,it aims to promote the price reform of basic medical services with the goal of balancing the interests of various parties,establish a supervision and management mechanism with efficient incentive price adjustment as the core,and constantly improve the operating level and capacity of basic medical service institutions.Sixth,it analyzes the reform of competitive medical service price.It is pointed out that the existence of competitive medical service has objective inevitability,which is caused by the serious functional insufficiency of both government and market.Competitive medical services are characterized by exclusivity,diversity,marketability and non-equilibrium.Although the competitive medical service market is an important medical service market,there are no separate statistics to reveal the development of this market.The only data that can be compared,including the relative number of the growth of private hospitals,public hospitals,the number of beds of private medical institutions,private hospital personnel and diagnosis and treatment,shows that the competitive medical service develops rapidly in our country,and the competition between public hospitals is fierce.In the price of competitive medical services,there are some problems,such as the pricing of competitive medical services is confused with other kinds of medical services,the price of competitive medical services cannot reflect multi-interest demands,and the pricing system of competitive medical services lacks.On the theory of competitive medical service,the theory of effective competition is the basic theory of competitive medical service price.It further points out the value of the introduction of effective competition in the profession of competitive medical service,sets up the price model of effective competition in medical service,analyzes the formation mechanism of competitive medical service price,and forms the policy support of effective competition in medical service price.The government has intensified efforts to relax the control of medical service prices,vigorously promoted the supply-side structural reform of the medical service industry,created a medical service market system conducive to competitive entry,and gradually established the dominant position of medical service institutions in the market.Seventh,it analyzes the price reform of special medical services.This paper analyzes the connotation of the special medical service,analyzes the characteristics of the universality of the special medical service,the specific function of satisfying consumption and the difference of the demand.This paper analyzes the reform of special medical services,and the problems of the lack of pricing subject of special medical services,the lack of unity of pricing and the failure to reflect the real value of special medical services.Based on the particularity of special medical services,this paper puts forward the negotiation game price theory of special medical services,and uses the game theory to analyze the one-stage and multi-stage negotiation game price,analyzes the formation mechanism of the negotiation price of medical services under the game equilibrium,and puts forward the corresponding policy propositions.Eight analyzes the innovation and policy support of medical service price management system.It will focus on the supply-side structural reform of medical services,the reform of hospital management system,the establishment and improvement of the price management system of medical services,the establishment and improvement of the medical and health security system,the acceleration of the construction of medical service personnel and the increase of financial support for medical services.The innovation of the paper is manifested in three aspects:First,based on "Opinions on Promoting the Reform of Medical Service Price",this paper proposes that the general requirements of the reform of medical service price should be people-centered and reflected in the multi-interest balance that the general burden of the masses does not increase,the medical institutions are sustainable and the medical insurance fund can bear.In designing the path of concrete reform,this paper analyzes the logic of price classification reform of Chinese medical service,puts forward the transformation of Chinese medical service classification reform by hospital classification to medical service products classification,and designs the three categories of medical service price reform,including basic medical service,competitive medical service and special medical service.It provides a new perspective for the study of medical service price reform and further enriches the study of medical service price reform.Second,starting from the formation mechanism of the medical service price market,the paper proposes that the reform of the medical service price should not be dominated by the government or the market.Different types of medical service have different attributes,and the price formation mechanism and policy orientation are also different.In the specific analysis,based on three different medical service products,the construction of different theoretical framework,to guide the reform of medical service price.Among them,the incentive regulation theory is used to analyze the formation mechanism of basic medical service price,the competitive market theory is used to analyze the formation mechanism of competitive medical service price,and the game theory is used to analyze the formation mechanism of special medical service negotiation bidding price.At the same time,the paper also points out that the theory of socialism with Chinese characteristics,especially the theory of price reform,is the fundamental principle to guide the price reform of medical service in China.The reform of medical service price in China should protect the fundamental interests of the people and obey the goal of the reform of socialist economic system.Thirdly,based on the classified research on the reform of medical service price,the paper proposes that deepening the reform of medical service price is the "right position" for the price of medical service,so that the medical service can be worth the money and reflect the comprehensive value.In terms of specific reform direction,the classified reform of medical service price should promote the transformation from the treatment of diseases as the center to the people’s health as the center,continue to solve the hot issues such as the difficulty and high cost of seeing a doctor,promote the construction of medical service with health as the center,value as the orientation and high-quality development as the principle,and actively give play to the role of the visible hand of the government.We will build a price control mechanism with the full participation of multiple subjects and reflecting the value of medical services,laying a solid foundation for building a healthy China.Due to the lack of statistical data of competitive medical services and incomplete analysis of its market supply and demand,there is no official statistical data of special medical services and the research on it is relatively weak in our country with almost no high-quality research literature,so the research in this part is relatively abstract.At the same time,there is no unified theoretical analysis frame to guide the reform,which is the future direction of further research.In spite of this,this paper makes a valuable exploration for pushing forward the reform of medical service price classification.