Study On The DRGs Payment System Of Medical Insurance In Yuxi City

Health is of top priority for human life,as the expansion of gray population,change of disease spectrum and environment deterioration,our national medical expenditure has been keeping growing,especially the recent years frequently see the civil complain seeing a doctor is expensive and difficult,the medical issue has been an outstanding problem in society.For long time the contradiction among the medical insurance fund security,medical demand of the civil and development of hospital has been existed,the priority of medical insurance working as the payment system is to realize expenditure balance with the fund security being guaranteed,the urgency of establishing a new disciplined medical insurance payment procedure which could not only restrain the medical businesses from making illegal profit but also supervise the medical behavior.The year of 2015 saw the country issue the Comments on Comprehensive Reforms in Plot City Public Hospitals(National Office(2015)#38),which pointed out the medical insurance shall strengthen its payment and supervise functions,the refonn of medical insurance payment system shall be deepened,the DRGs payment method be encouraged.The city of Yuxi in Yunnan Province has been listed among the national pilot cities which try the hospital reform in 3rd series,Yuxi has been trying to find a breakthrough in DRGs method since 2017,pushing the city-wide public hospitals starting reforming.This paper focuses on the DRGs payment method reform in Yuxi,have searched the relative domestic or foreign academic documentation grasping the reform status in other countries and regions as well as the global latest academic results,collected and rated the data produced by the two years,local reform,would present the below contents:The general introduction about the research background,method,outline,relative theoretical support and DRGs concept explanation,the stakeholder analysis and comparison among different payment systems,the success experience in DRGs payment reform of America and other countries followed.The DRGs payment reform would be individually reviewed from the two perspectives of DRGs calculation groups,policy and system development,the according technological,payment and medical service performance would be rated,trying to find the problems in Yuxi DRGs payment system and give suggested solutions by data comparison and analysis.After two years of practice,the DRGs payment system in Yuxi has curbed the rapid growth of medical expenses,improved the efficiency of medical insurance funds,and greatly reduced the burden of medical expenses of insured patients.At the same time,it urges hospitals to strengthen fine management and make progress towards improving quality,increasing efficiency,reducing costs and controlling costs.Yuxi takes DRGs payment as a breakthrough to promote the deepening of medical reform and the sustainable development of health care.