Analysis Of Single-disease-payment Method And Forecast Payment Standard

With the rapid development of health care in recent years,the masses of the people for the quality of medical services requirements are getting higher and higher.Medical insurance system as a basic system to ensure people's livelihood,after 60 years of continuous development.China has gradually formed the current medical insurance system,health insurance covers the vast majority of the country's population,to bring more people a lot of medical on the help and convenience.But at the same time,there have been many problems,such as difficulty of getting medical service,high medical costs,"big prescription",excessive medical care,insurance fraud and other issues emerge,above problems often can be seen on newspapers,Medicare fund waste is very serious.All of the above problems bring a heavy burden to the health insurance institutions in actual operation.In summary,this paper argues that it has great practical significance that study the payment of medical insurance from the perspective of medical insurance institutions.In order to protect the healthy operation of health insurance fund,reduce the burden of health insurance institutions.The most urgent thing is to change the way of medical insurance payments,that is the way of medical insurance institutions compensate for the specific medical expenses to the hospital,most of our country is still paid in accordance with the service.Some payment methods were appeared in recent years,such as single-disease-payments,pay-per-hospital day and disease-related groups(DRGs),and other payment methods.Single-disease payment refers to the classification of disease through a unified classification of disease.scientifically developed a fixed rate of compensation for each disease(the standard close to reasonable,reasonable and legitimate medical costs),medical insurance institutions in accordance with the standard and hospitalization Fixed-point medical institutions to pay the cost of hospitalization.Single-disease payment has the advantages of convenient settlement and obvious control effect,but the difference between the different patients in the horizontal direction leads to the fluctuation of the actual treatment amount.Vertical point of view over time,single disease pricing standards always immutable,how to develop a reasonable pricing standards and with the passage of time and scientific adjustment,has become a big problem in front of the health insurance department.For example,in Dalian City,due to many single-disease payments of diseases standards had built long years ago and pricing standards for many years had not changed.Up to now,many standards is significantly insufficient to meet the average level of treatment costs.At the end of each year,Medical insurance institutions have to subsidize the hospital,so the final risk completely transferred to the health care agency itself.This phenomenon is a very damaging effect on cost control.Based on the actual situation of single-disease payment in Dalian city,this paper starts from the influencing factors of the actual expense difference,and then improves the way of variable weight forecasting.Further forecast the budget of payment of medical insurance fund,provide a reference for medical insurance institutions to develop a more reasonable single-disease pricing program.This paper first enumerates the current background of domestic and foreign medical insurance payment,and further compares and analyzes some of the existing payment methods.In the third chapter,the data of psoriasis single-disease patients in a hospital in Dalian were studied.The variance analysis,correlation analysis and regression analysis were used to analyze the data,the factors influencing the difference of actual cost were summarized.In the fourth chapter,in view of the current unreasonable pricing standard for single-disease payment in Dalian,so that the medical insurance institutions will give hospitals extra subsidies in a huge amount every year,which resulting in a huge waste of the expense.Further innovating the combined point variable weight prediction model to predict the actual expense of the single-disease of colorectal cancer in a hospital in Dalian.After predict the actual expense,I found that the error between the predicted value and the true value is very small,thus mastering the law of growth of colorectal cancer single-disease payment expense.On the basis of this,it further puts forward the time-varying forecasting model for single-disease payment of colorectal cancer,determines a new single-disease pricing method,provides a reference for the medical insurance institution put forward a more reasonable single-disease payment budget,reduce the waste of the medical insurance fund.The first innovation point of this paper is to consider the factors that affect the different of patients' expense in the analysis of the total cost,by the type of patient payment,age,number of hospitalizations and other information of patients to fully consider.The second innovation point of this paper is the combination point variable weight prediction model is introduced into the forecast of the actual expense of the single disease,and the forecast value can be very close to the real value,the result is satisfactory.The paper also deliver a new type model of disease pricing is the predictive model of single-disease of colorectal cancer,which provides a feasible solution for the medical insurance institutions to predict the expense amount of single-disease payment.Finally,in view of some specific situations found in the study,this paper puts forward some suggestions to our medical insurance management department.First of all,policy makers should actively promote the implementation of single-disease payment,and the use of scientific and reasonable means of measurement,so that they do not damage the enthusiasm of the hospital under the premise of reasonable control costs.Secondly,the health insurance department should Increase publicity efforts about control expense of medical insurance to the whole society.Thirdly.Policy makers should set the appropriate reward and punishment system.Reward hospitals who Finish target good.On the contrary,they also punish hospitals who has an excessive consumption.such as cut the budget for the next year of the hospital and so on.