A Study On The Mode Of Medical Insurance Payment

The problem of medical insurance is a world hard nut. Medical insurance system should ensure participant's health effectively. On the other hand, it also demands to keep the medical insurance expenditure within an acceptable range, keeps the balance betwent fund's revenue and expenditure, avoids financial crisis, so as to affect sustainability of medical insurance system and participants'health.An effective way to achieve two functions which addressed above is the mode of medical insurance payment. As consering in this thesis, the medical insurance payment method is an accustomed definition for the medical insurnce field, namely the way how the medical insurance departments pay participants'medical expense to fixed medical service institutes, and relative rules which how compensations are provided by the medical insurance departments for medical service institutes. It excludes the payment of need (patients) and medical service providers.Under the condition of the social medical insurance departments as the third party pay the medical service cost. The concept and position of medical insurance payment is defined plainly, and the comparison research and theoretical analysis did on various payment methods.In 2002, Zhenjiang city initially practiced the social medical insurance system in china, setting up the multi-layer social medical insurance system gradually. This thesis summarizes the four-stage evolvement process of medical insurance payment in 10-year medical insurance reform of Zhenjiang, and analyze theory of medical insurance payment through seting up the function model, using game theory and the information economics foundation theories. It also appraises operating performance of medical insurance payment from the horizontal and vertical dimensions, analyzes the applicability of the medical insurance payment method of Zhenjiang city, compares four kinds of typical medical insurance nation payment methods with ones of zhenjiang city .According to the related theories and Zhenjiang's medical insurance practice, the author analyzes the considerable problems on how to constitute medical insurance...