Study On The Payment Method Of Medical Insurance

The implementation of medical single disease payment is a key link in the medical insurance system reform. Its goal is to reasonably control the degree of medical costs increasing, improve the quality of medical services,and solve the problems of difficult and expensive medical treatment. Based on the specialization of health insurance relationships and the complexity of medical insurance operation mechanism, this paper takes Rizhao city’s medical insurance payment reform as the research object under the Incomplete Contract Theory and the Principal-Agent Theory. On the one hand, this paper compares and analyses the impact of single disease payment of laparoscopic surgery of gallbladder and appendix under medicare on the control of the rising health care costs and the improvement of the patients’ satisfaction to the medical management. On the other hand,this paper analyzes the problems what the single disease payment method is facing,and gives suggestive advise proposed to improve the single disease payment method under medical insurance as following. First of all, establish a system of research and development and clinical trials cost whose high value medical supplies are borne by the public sector, and a monopoly system of medical supplies, so as to filter out the multilayer of profit during the research and development, production and marketing chain of high value medical supplies. Secondly, the insurance agencies should be involved in the management of high value pharmaceutical supplies in hospitals, and jointly discuss and make reasonable directory of single-use and re-use high value pharmaceutical supplies with medical institutions. Besides, the insurance agencies should also participate in the bidding and purchasing of medical consumable materials, and explore the price negotiation mechanism to control the price of single disease payment. What’s more, each disease should be divided into high cost line cases, middle and low cost cases and other diagnostic groups according to the severity of the disease and the intensity of medical services, and a standard of elastic charges should be taken. Furthermore, the management information system of medical insurance based on single disease payment should be established, and the standard and clinical pathway of single disease payment at all levels should be opened, and the operation status of single disease payment by medical institutions should be monitored and early warned. Last Adjustment mechanism of the doctor-patient relationship of the single disease payment should also be established, so as to form the forced mechanism helping to improve the hospital operational efficiency, and expand revenue growth under constraints of the budget. Last but not least, patients’ satisfaction evaluation and self restraint mechanism for medical institutions should also be established.