Research And Comparing On Medical Insurance Payment Pattern Between China And America

Medical insurance is one of the most important components in social security.It plays a important role in relieving the burden of people's life,improving people's quality of life and maintaining social order.It has unshirkable responsibility in meeting the need of medical services.Nowadays,however,medical insurance incurs some problems,such as "It costs a lot when people are ill and is hard to see a doctor.",the excessively speed in medical expenses growth,the more burden of participants and large fiscal fund pressure.It has become a very concern in the government and the people.Against this background,medical insurance payment becomes the target of public criticism of the government.The government puts the hope on the reform of medical insurance payment which is able to ease the problems above.Over the years,we have been trying to reform medical insurance payment,from post-pay system,such as Fee-For-Service,to prepaid system which is carried out now;from the single payment in the past to today's complex payment,we can see medical insurance payment is getting more scientific and reasonable.The author considers that it is very necessary to sum up predecessors'experience and learn a previous lesson from the predecessors in the way of reform.Thus,the author selects the United States as the research object,compare the medical insurance payment between China and America,and expects to contribute to China's medical insurance payment reform.The United States is the country that has the largest spending on the medical and health care all over the world.And the reform of medical insurance payment starts early,and has been exploring the medical insurance payment that can control the increasing medical expenses.There is success and failure in the process of exploring which is valuable lessons for us after summing up.Based on medical insurance payment status quo of China and the United States as the breakthrough point,used comparative analysis,literature research,methods of foreign reference method,experience method,expounds the status quo of China's medical insurance payment,and the total amount of advance will shuffle in severe cases,prepaid system will reduce the total system of medical service quality,total advance measure appear deviation,according to the macro-reforms will transfer the costs of medical problems.The cause of these problems is the payment of the supervision mechanism is not sound and it's hard to distinguish reasonable and unreasonable fees.At the same time also introduced the United States the present situation of the medical insurance payment methods,effects and the reform experience,and both sides of the effect of the content of the medical insurance payment methods,reform,reform progress has carried on the comparative analysis,it is concluded that the medical insurance payment methods,and to China's medical insurance payment gives countermeasures and Suggestions,advice can be divided into two aspects,on the one hand is advice about payment micro influence factors,on the one hand,is about the macro factors affecting medical insurance payment advice.Advice about payment subjective factors are:the formulation of payment to adjust measures to local conditions,following the management type medical payment,promoting national complex mode of payment,speeding up the press disease to the transition of DRGs.Advice about payment objective factors include:perfecting the management measures and rewards and punishment mechanism,and actively introducing fees payment negotiation mechanism,scientific standards for total amount prepaid.