Study On Outpatient Coordinating Payment Policy Of Basic Medical Insurance For Town Citizens In China

Objective：In order to establish the framework system of outpatient coordinating payment policyof basic medical insurance for town citizens in China which adapt to the development of ourcountry’s politics, society and economy.Methods：(1)Review the literature and analyze the information;(2) Field research andSemi-structured interviews;(3) Typical case analysis;(4) Focus group discussion;(5)Comparative analysis.Results：(一) Literature analysis: The main problems of outpatient coordinating payment policyare the scope of protect, pay range, the benefit payment policy, capitation and health servicemanagement and so on.(二)Comparative analysis of outpatient coordinating in four researchcities and14other cities: The coverage only contains general outpatient, different paymentstandards, the copayment ratio is between40%and100%,15cities implement capitationand fixed-point medical treatment. Then overviewing and analyzing the features ofoutpatient medical payment system in China.(三) By overviewing and analyzing successfulexperience of foreign outpatient clinical benefit, then learn some useful things.Policy recommendations: (一)Break the boundaries between ordinary out-patient disease and outpatient illness,and determine the coverage of outpatient medical services from thinking the basic principlesof economic risk from health insurance: mainly protect outpatient medical services with higheconomic risks and vulnerable groups.(二)The medical clinic project and the pay range ofdrugs which are different from inpatient but adapted to outpatient coordinating should bestudied and formulated.(三)Different outpatient payment policy must be developed betweenmedical treatment costs and drug costs.(四)We must adhere to capitation payment system,study and design the internal mechanism of capitation payment system comprehensively andsystematically, and important external system which affects the role ofcapitation.(五)Medical insurance management system needs to be further improved andclassified management of sentinel physicians should be established which is compatible withthe outpatient co-ordination system.(六)To establish the budget control system of residents’health insurance stratification and classification based on negotiation mechanism.(七)Inorder to provide technical support for capitation, we should strengthen the construction ofinformation system and information monitoring.