Study On The Reform Of Basic Medical Insurance Payment Mode For Urban Workers In Shanxi Province

In 2017,the state council issued the pilot work of comprehensive promotion of disease diagnosis related sub-group(DRGs),and then the provincial human resources and social security departments further issued the implementation plan,making the reform of the new medical insurance payment mode urgent.Since 1998,China has been continuously promoting the improvement of medical insurance payment methods.Due to the differences in the medical environment,medical facilities,medical staff quality and policy environment between different regions,it is still impossible to implement the reform nationwide,so it can only be carried out on a small scale in each province.In the study of the problem also need to select a certain area for field analysis is meaningful.Based on the payment of medical insurance for urban workers in Shanxi Province as the research object,on the urban employee basic medical insurance and medical insurance payment on the basis of elaborating the basic concept,the integrated use of field investigation,comparative analysis and other research methods,new medical insurance payment can improve the medical environment in the province,effectively control the unreasonable growth of medical treatment charge,in the process of implementation problems are discussed in this paper.With the help of macro data analysis,and taiyuan city as the representative of the city on the local urban workers basic medical insurance enrollees about the medical insurance payment method related questions of questionnaire survey and field interview,the status of Shanxi Province urban workers basic medical insurance payment method was analyzed.It is found that the new payment method of basic medical insurance for urban workers in Shanxi Province has improved the environment of medical payment and the phenomenon of excessive growth of medical expenses to some extent.It is also widely believed that the innovation of medical insurance payment method is beneficial to curb urban medical expenses,but the overall satisfaction is not very high,especially the policy of mixed payment method needs to be further promoted.Combined with the "4E" theory,the paper analyzed the improvement results of the medical insurance payment method for urban employees in Shanxi Province,and extracted four dimensions corresponding to the increase in expenditure,insufficient liquidity,insufficient sustainability and insufficient fairness.On the basis of drawing lessons from the experience of the reform of social health insurance payment methods in Germany and the United States,which are typical countries abroad,this paper puts forward some suggestions on the problems found:further perfecting the medical insurance information system and DRGs payment mechanism,Further improve the medical insurance information system and DRGs payment mechanism,improve the internal supervision and management mode and level of medical institutions,so as to provide a reference for promoting the better implementation and implementation of the new payment mode of basic medical insurance for urban workers in Shanxi Province.