Yunnan Province Town Worker Is Basic Medical Treatment Insurance Payment System Analysis And Diseases-related Quota Payment Of Feasibility Study

The high medical costs have benn the problem of the world in medical field face. Inall the countries in the world has been studying how to reduce health-care costs andplayed a positive role. At present, the medical field in general medical expenses thatcontrol, make the standardization of the supplier’s medical institutions serviceproviders) is a kind of effective behavior is better than a standardized demand-sideknow nothing. This is because a important part of medical treatment insurance, to paymedical treatment insurance is an effective way to achieve security function of themedical insurance. Compared with the traditional overdraft.System now prepaidsystem is advocated more and more widely by many countries, as a representative ofprepaid system,"DRGS" model has been more and more countries to accept. Atpresent, many countries also effectively control medical expenses by "DRGs" mode,in many areas and our country DRGS also try and played a positive role. However,because the huge number of population, the vast area field, spectral distribution ofcomplex disease, in addition to that, the technology is DRGS still not mature, so thereare still many difficulties in the implementation of disease management mode.As an important province in southwest China, yunnan is reform medical insurancepayment system constantly in these years, but the trend of rising medical costs are stillvery obvious, and the requirements of the total advance the reform has not beencarried out, but in addition, management system has not been set up scientific andreasonable in the fund budget and classification management. Based on the existingresearch results and relevant theoretical generalization, in this article we will compareseveral different medical insurance payment mode, analysis and evaluation of thebasic medical insurance payment operation in recent years of yunnan city workers;Although the show in yunnan area of town worker is basic medical insurance fundbalance, disease management pattern, the treatment of medical treatment insurance,points out the existing problems of the payment system. And then with the general medical insurance payment system content in Germany and the United States. Mainthe advantage of learning DRGS the implementation effect, in these countries ofmedical expenses control. The table of some countermeasures and Suggestions to thecurrent situation and problems of yunnan province town worker medical insurancepayment system and comprehensive application DRGS, including various payment,according to the diversity of the medical service, the pay range is very wide, from themedical and health services and to promote healthy gradually extended to relatedservices, according to different levels of hospital in different payment, and bring intofull play, and on the basis of community health services in the medical service, playthe role of medical insurance negotiation mechanism and introduce points, whichshould be paid attention to in the implementation of the disease management mode.Hope this will help to solve the existing problems and improve the insurance paymentsystem.