Research On The Formation Mechanism Of Medical Service Price Negotiation Based On Stakeholder Analysis

Objective:The formation mechanism of medical service price negotiation is the design of the framework of negotiation mechanism,which has a key role in the process and outcome of medical service price negotiation.First of all,the stakeholders of medical service price negotiations were involved in the definition and classification of righteousness,will support the inclusion of stakeholders in more than 70% and as the object of the core interest,can be used as the medical service price negotiation subject.Secondly,using matrix analysis,combined with empirical data to explore the power and interests of the main body of medical service price negotiation.Third,according to the medical service price negotiation subject rights and interests analysis and expert advice,framework design of medical service price negotiation mechanism,for establishing the medical service price negotiation mechanism and Realization of medical service price reform interests win-win goal to provide reference.Method:1.Literature analysis.Through CNKI,electronic library,archives,Internet and other means to collect and sort out relevant interests at home and abroad related theory and literature,summed up the governance of stakeholders in the enterprise management of public hospitals,research,application research and reform of payment of medical services price pricing research,to provide theoretical reference for the stud y.2.Questionnaire.The Mitchell score,based on those engaged in health care,medical insurance,medical records,financial health and other leaders,experts and scholars conducted a questionnaire survey of stakeholders judge definition,determine the negotiations with the price of medical services in relation to stakeholders.According to the respondents to the interests of the "power","legitimacy","urgency" of the 5 dimensions of the situation,the medical service price negotiations stakeholders classification.With the support of analysis and classification criteria,will meet the following 2 conditions: the support of more than 70%;the core stakeholders belong to at least 2 dimensions score more than 3 points and 3 points higher than the average,as the subjects of negotiation.3.Power benefit matrix analysis.According to the results of the Mitchell score,the author analyzes the bargaining power of the main body in the dimension of power and urgency.Based on the analysis of the empirical evidence,this paper discusses the characteristics of the power and interest demands of the main body of negotiation,and provides the basis for the discussion of the formation mechanism of the multi participant negotiation pricing.4.Statistical analysis.Descriptive analysis was used to compare the support degree of each stakeholder and the Mitchell score to define and classify the stakeholders of the medical service price negotiation.Collected in 2006-2015 China Statistical Yearbook evaluation indicators,through descriptive analysis,observation of the trend of changes in the indicators for the analysis of the main powers and interests to provide empirical evidence.The financial department: a collection of government health expenditure indicators Medical insurance institutions: the collection of health care expenditure indicators Patient: collect personal health expenditure of urban and rural residents,medical expenditure,medical institutions of different types of hospitalized inpatients per index patient data both times the cost,different levels of hospitals.Medical institutions: the collection of hospital income and expenditure,personnel expenditures,medical staff salaries and other indicators.Result:1.In accordance with the inclusion criteria of negotiation subject: social medical insurance institutions,health administrative departments,the development and Reform Department of NCMS,clearing institutions,financial departments,hospital managers,grassroots medical institutions,patients and their families.2.According to the Mitchell score and data analysis,through the matrix analysis,the author discusses the power and interest demands of the main body of the negotiation.Specifically as follows:(1)Government departments: high power / high social interests.The financial department of the medical service financial funds,through the financial capital investment to ensure the fairness and effectiveness of medical service resources;the administrative department of health is the health policy planners.Through the adjustment of the price policy,to ensure the rationality of the allocation of health resources,public welfare,standardize the order of the medical service market.The development and reform department is the formulation,monitoring of the price level,through reasonable adjustment of project price level,maintaining the stability of the market price.(2)Medical insurance institutions: high power / high economic benefits.Have the right to pay medical insurance and supervision.Expected to reduce the unreasonable expenditure by means of payment reform or price adjustment,to ensure the safety and effectiveness of the use of funds.(3)Patients and their families: low power / high economic benefits.The use of medical service.Freedom of choice for medical services,but lack of initiative.Medical service prices to reduce or increase the proportion of Medicare reimbursement.Get reasonable and effective medical service,reduce medical expenses.(4)Public hospitals: medium power / high economic benefits.Medical service price policy.As a hospital administrator,has the absolute decision-making power of internal management,and hopes to maintain the sustainability and stability of economic operation through price reform,and achieve social and economic benefits through effective internal management.Medical staff at the bottom of the passive position,lacking of initiative,hope to improve the pay and benefits,to achieve self-worth.3.Based on determining the subject and the subject analyzing of negotiation power and interests to design multi equal participation in price negotiation mechanism.The core mechanism factors mainly include the subject orientation and duties and content of the negotiations,the negotiations on the basis of the subjects of negotiation,the negotiation should follow the principle and mode of negotiation.(1)The main position: the need for medical insurance institutions need to strengthen the identity of equal buyers,suppliers of medical institutions need to enhance the main consciousness,enhance the ability to negotiate.Government departments such as health administrative departments,human and social sectors,the development and reform department,the financial sector and so on as the negotiation system and rule makers,medical service price negotiations organizers and executive supervisors involved.(2)Main responsibilities: government departments as a management subject of medical service price is mainly to develop rules,coordination of interests,supervision and negotiation behavior;medical institutions as a service provider subject,mainly is to protect the quality of service,improve internal management,to maintain the hospital continuous operation;health care institutions as the purchase of the service main body,mainly to do the fund budget,reasonable,safe and effective use,protection of the insured interests etc..(3)The main contents of the negotiations: the price of medical services,medical insurance payment methods and payment standards(price)as the core of diversification.(4)The difference of negotiation: According to the different content of the negotiations,the negotiation subjection based on the existence of differences.Medical institutions are mainly based on cost accounting and historical cost,medical insurance institutions are based on the standard clinical pathway and historical data.(5)The principle of negotiation: to follow the main principles is to take into account the interests of all parties,equal consultation and negotiation,multiple acceptance adhere to the basic principles of public welfare,full information sharing,to achieve mutual benefit.(6)The level of negotiations and mode: better negotiations at the municipal level,suggesting the same level,the same type of medical institutions can be combined with the insurance agencies to negotiate,forming a unified price level.(7)The negotiation process is divided into the preparation phase,negotiation stage,implementation phase.4.Price negotiation supporting mechanism: supervision and management mechanism,dispute settlement mechanism,incentive restraint mechanism,information sharing mechanism.Suggestion:1.The implementation of stakeholder classification management,focusing on coordinating the interests of the core stakeholders2.Negotiating the role of the subject and building a common interest governance mechanism to achieve a win-win situation.3.Establish a unified and coordinated level of negotiations,to determine a reasonable basis for negotiations and negotiation standards4.Improve the cost accounting system and information technology,to provide the basis for the price negotiations fine negotiation5.Improve the medical service price reform system top-level design,promote medical services price negotiations6.Learn from the mature experience of drug price negotiation,establish the dynamic adjustment mechanism of medical service price...