The Study Of The Payment Of The Basic Medical Insurance Benefits For Urban Workers In Huanggang City, Hubei Province

The basic medical insurance system for urban workers in China is built up with the changes in the socio-economic development and China’s demand and supply for medical services. In order to achieve balanced to control the unreasonable growth in medical costs and improve the quality of medical services, a reasonable payment as a constraint adjustment mechanism must be build.There are five ways for medical insurance payment. They are Fee For Service, Capitation Payment, Diseases Related to Groups, Flat Rate and Scale Payment. Each one of them has advantages and disadvantages. And Fee For Service is a retrospective payment, others are prospective payments. Fee For Service was used as the only way when the basic medical insurance system for urban workers in China was built. Then the drawbacks came out in practices, the expected benefits and costs have a serious imbalance. So our country began to seek new payment reforms.Huanggang City, Hubei Province, responded positively to the national call. And according to actual local situation, it has turned the FFS under the total control to a fixed payment that DGRs combine to Flat Rate in a decade. And the payment will be changed towards the Scale Payment way.By the practical experience of Huanggang, it shows us that the retrospective payment is significantly better than prospective payment in cost control. However, there is no single payment way can achieve the desired objectives completely. The best way is to look for a mixed payment way while turned prospective payment into retrospective payment. It has reached a consensus around the country on that. Huanggang should follow the national future development trends, select a combination of the appropriate way to pay for the actual local situation, and improve the medical insurance payment system.