Medical Insurance Payment Method Research

In the medical health field of our country, reforming health insurance payment method isthe key to solve the problem of continually increasing of medical expenses and high medicalcosts. Through this reform, it will monitor and control the behavior of the medical institutionspreferably, and then keep the basic medical service consumption to the local proper level,thereby using the limited medical insurance fund effectively and ensuring the ability of medicalinsurance fund to resist risk. At present, there’re six kinds of medical insurance payment methodin the world, including Fee for Services, Diseases Related to Groups, Scale Payment, Capitation,Flat Rate, Quota Settlement. Each payment method has its advantages and disadvantages. Inpractice, we can use the combination of different payment methods according to the actual need.At present, China has basically built up a new type of rural cooperative medical care, urbanworkers, basic medical insurance for urban residents Trinity social health insurance system. andIn a unified frame, the payment method is different in different areas. From the practice ofGuangzhou, Shanghai, and Jining, etc, the payment method has basically realized the control ofmedical expenses growth and reducing personal financial burden. But there are also problemswhich need to be further perfect, such as lack of internal management in designated hospitals, theprominent contradiction between the medical demand and cost control, and the high cost oforganization management.Taian has practiced a payment method that included total quantity control, quota payment,service unit and flexible management. In this method, a good result has been achieved. Forexample, the per capita hospital costs raise reasonably, the hospitalization rates raise slowly, andper capita expenditure reduces step by step. Referring to the experience of the basic medicalinsurance payment methods in Taian, if we want to improve the basic medical insurance paymentmethods in our country, we should refer to the advanced experience of developed country,Accelerate the basic medical insurance system for the integration of urban and rural residents,consummate the fund budget management system, promote the hierarchy management of thedesignated hospitals, establish a experts negotiation mechanism and Strengthen the managementcapacity of the health insurance agencies Managers.