The Research On Evaluating Hospital Economic Operation Effect Of Medical Insurance Total Payments Control Policy

Background:along with the deepening medical and health system reform in China step forward, the problem of reform of public hospitals is increasingly outstanding, rapidly rising medical cost, medical insurance fund expenditure scale expanding, the problem of "Difficulty and Gigh Cost of the Getting Medical Servic" is still one of the major livelihood issues of social and economic development in our country. Payment reform as an important part of the public hospital reform, play a key role to control health care costs, the various provinces and cities in our country as a whole the area are actively explore the payment reform of cost control, reform is imperative. In 2013, guangxi zhuang autonomous region, the OuZhi in nanning unit worker is basic medical treatment insurance fixed-point medical institutions to carry out the medical insurance payment total amount control method of payment reform.Purpose:this study through the design of total amount control and the effect of the implementation of the case hospital research, analysis of the hospital implementation and countermeasures, and evaluation of the policy of economic operation, especially in a hospital medical treatment and health care costs, time costs and to explore the influence of the problems and causes of the problem, and constantly improve the total medicare payments for the future control policy rationalization proposal is put forward.Methods:through literature research and field survey, sums up the domestic and foreign relevant theories of total amount control and evaluation theory and analysis method of economic operation of the hospital. Through field investigation, the relevant personnel to carry out the semi-structured interviews, to understand the total control scheme of the implementation of the background and execution, collected between 2010 and 2013 cases of hospital patients related data and N city medical insurance fund based data. By utilizing the analysis method of "Structure-Conduct-Performance", this study address a qualitative analysis on the project of the reform, the hospital management measures and cognition of medical staffs. Using SPSS21.0 statistical software for data cleaning and statistics, the integrated use of hypothesis test, interrupt time series analysis and times difference method, from the medical services, work efficiency, medical expenses and medical quality of four dimensions, from hospital overall situation, the worker medical insurance patients before and after the reform of the overall situation, worker health clinic/hospital patients compared with typical disease group from four aspects to carry out data analysis, to evaluate the implementation of medical insurance payment total amount control effects on hospital economy operation.Results:after medicare pay total amount control policy, has been accused of cost consciousness in designated hospitals, medical insurance fund expenditure growth trend gradually return to a normal track. Medical services in the overall rise, the medical service efficiency further; To effectively control medical costs rapidly rising trend, but the effect is limited; Health care costs under control, the fund operation in good condition; All costs falling growth rate, effectively control medicine proportion; Hospital actively strengthen cost control and management of medical service quality.Conclusion:the medical insurance payment paid total amount control has a certain scientific nature and rationality, total amount control policy implementation effect is preliminary already appeared. But there are also some problems in the process of policy implementation, to perfect the medical insurance payment total amount control scheme, put forward the following Suggestions:reasonable standards for general control index calculation model and settlement; A serious illness insurance policy, combined to implement the basic medical insurance and medical treatment of a serious illness insurance; Strengthen the internal operation and management of medical institutions, to carry out the department responsibility; Further exploration under the general control policy of DRGs payment method.