Study On The Evaluation And Optimization Strategy Of Medical Insurance Reimbursement Proportion Gap Policy In Graded Medical Service System

According to the theory of health service demand,the demand for health service is influenced by income,preference,price and expectation of related goods.In this regard,the government through policy guidance is conducive to enhancing the utilization of health resources,so as to more clearly and more targeted to meet the needs of both supply and demand.China's long-term health care system is a "inverted triangle" model,even the hospital is a large comprehensive hospital in addition to solve all kinds of Difficult miscellaneous diseases ICU,still struggling to cope with a variety of common diseases,health and technical personnel work of the hospital and a heavy burden;basic medical and health institutions is a deserted house,medical resource utilization is worrying.In the current medical environment,establish and improve the classification and treatment system to improve the efficiency of utilization of health resources,solving the "difficult and expensive" problem,promote the formation of "minor illness into the community,serious illness in the hospital" new medical pattern plays a crucial role.Based on the background of the medical insurance system reform in Wenzhou City,using the method of literature analysis and combing the development,classification and treatment system of Wenzhou city construction of the policy implementation the inductive mode classification of diagnosis and treatment in China,analysis of factors on the implementation of grading treatment system and the influence of Wenzhou urban and rural residents using the questionnaire survey method and mathematical statistics.According to the Wenzhou classification of the status and effect of treatment model play,put forward to perfect the diagnosis classification model,promote the optimized allocation of medical resources of the policy recommendations.The study found that(1)Due to the traditional concept of medical treatment,referral channel blockage,medical institutions and medical institutions at all levels of information Limited reimbursement gap is not the existence of the problem,the guiding role of medical insurance policy in Wenzhou is still limited in grading treatment.(2)Through single factor and correlation analysis results showed that the age,education level,family income,medical site close to home,the symptoms are the influence factors of urban and rural residents in the first primary diagnosis,age,medical insurance,waiting time,community service level is high,serious symptoms is affected by the single factor and the related analysis results,age,educational level,family income,medical site close to home,the symptoms are the influence factors of urban and rural residents in the first primary diagnosis,age,medical insurance,waiting time,community service level is high,severe symptoms are the influence factors of urban and rural residents in the first primary diagnosis behavior,influence factors to grassroots first diagnosed between urban and rural residents the intention,influence factors of behavior in the first diagnosis of medical insurance,waiting time and residential community service level three factors.The reason is that health care for the residents to reach more policies,and thus will choose grassroots first diagnosed to get higher reimbursement;and secondly wait time advantage behavior will reduce the cost of medical treatment of patients,which will increase the attractiveness of urban and rural residents;the three residential community service level improvement can make the patient to feel tangible benefits,which can eliminate the heart of all the concerns of the grass-roots hospitals,which will have a positive role in promoting the urban and rural residents in the first primary diagnosis behavior.The influencing factors of the first visit behavior of urban and rural residents,relative to the willingness of the first visit of residents in urban and rural areas,the influencing factors of the first visit behavior were higher than the three factors of medical insurance,waiting time and service level of residential community.The reason is that health care for the residents to reach more policies,and thus will choose grassroots first diagnosed to get higher reimbursement;and secondly wait time advantage behavior will reduce the cost of medical treatment of patients,which will increase the attractiveness of urban and rural residents;the three residential community service level improvement can make the patient to feel tangible benefits,which can eliminate the heart of all the concerns of the grass-roots hospitals,which will have a positive role in promoting the urban and rural residents in the first primary diagnosis behavior.Based on the above research results,proposes to strengthen the guiding role of grading in the diagnosis and treatment of the proposals in this paper,one is the connotation construction optimization conjoined,two is the policy guarantee mechanism to improve the classification of diagnosis and treatment,the four is to increase policy advocacy efforts,the five is the construction of information platform.