Research On The Suitable Payment In Clinic And Hospital Of New Rural Cooperative Medical System In Zhejiang Province

Objective:New rural cooperative medical system mainly consists of the health department supervisor mode,the labor and social security department supervisor mode and the commercial insurance company supervisor mode.Explore suitable payment methods under new rural cooperative in three management models,providing policy advice to advance the comprehensive reform in rural health.This paper tries to explore suitable payment method in outpatient and inpatient under the management models through building mechanism of related benefit balance in payment of outpatient and inpatient under three management modes and empirical analysis of implementation effect of new rural cooperative medical system payment in Zhejiang Province.Methods:(1)Get a comprehension about Related concepts and performance target of new rural cooperative medical system payment through review of literature;(2)Use benefit counterparts and game theory to build mechanism of related benefit balance in payment of outpatient and inpatient under three management modes.(3)Determine assessment criteria about implement effect of payment methods by adopting focus group discussions;(4)Make a empirical analysis of effect in new cooperative medical system payment by RSR and TOPSIS methods in Zhejiang Province;(5)Analyze problems,causes and solutions of payment reform by focus interview method.Results:(1)Game analysis discovery the first model should adopt capitation for outpatient and DRGs for inpatient;the second model should adopt the global budget for outpatient and DRGs for inpatient;the third model should adopt the global budget for both outpatient and inpatient.(2)Comprehensive evaluation of implementation effect of new rural cooperative medical system payment in Zhejiang Province show that the average expense quota is the optimal for outpatient of the first model and combined DRGs and the average expense quota is the best for inpatient;the average expense quota is the optimal for outpatient of the second mode and combined the global budget and DRGs is the best for inpatient.the global budget is the optimal for outpatient of the third model and combined DRGs and the average expense quota is the best for inpatient.(3)The study puts forward that the average expense quota is the optimal for outpatient of prosperous economic area and DRGs is the best for inpatient; Combined the global budget and the average expense quota is the optimal for outpatient of general economic area and the average expense quota is the best for inpatient;The fee for service is the best for outpatient and inpatient of the developing area.Conclusions:(1)The study puts forward that the first model should adopt capitation for outpatient and combined DRGs and flat rate for inpatient.The second model should adopt the global budget for outpatient and combined the global budget and DRGs for inpatient.The third model should adopt the global budget for outpatient and combined the global budget and flat rate for inpatient.(2)The study puts forward that prosperous economic area should adopt combined post-payment and pre-payment for outpatient and combined pre-payment and mix-payment for inpatient:General economic area should adopt pre-payment and mix-payment for outpatient and inpatient;The developing area should adopt post-payment.(3)Promote payment reform from post-payment to mix-payment which give priority to pre-payment; The reform of Payment should be in coordination with reform of medical institutions mechanism; The payment reform should be promoted through institution, economic, culture and so on.