Study On The Reform Of Payment Mode Of Basic Medical Insurance In Guilin

In recent years,with the continuous increase in medical expenses and the escalation of contradictions between doctors and patients,in 2011,the Ministry of Human Resources and Social Security put forward the "Opinions on Further Promoting the Reform of Payment Methods for Medical Insurance".In 2017,the General Office of the State Council issued "Guiding Opinions on Further Deepening the Reform of Basic Medical Insurance Payment Methods",the pace of reform of payment methods has never stopped,and cities across the country are actively exploring the path of reform of medical insurance payment methods.The purpose of the payment method reform is to ease the contradiction between doctors and patients,not only to ensure the quality of medical services,but also to effectively control medical expenses,so that everyone can personally understand the good results brought about by the health care reform.This article takes the status quo of "difficulty in seeing a doctor and expensive medical treatment" as the entry point,and proposes that under the dual pressure of policy background and realistic background,medical payment methods must be reformed.First of all,this paper defines the concept related to medical insurance payment methods,expounds the medical insurance payment method and cost control theory,and also analyzes the advantages and disadvantages of each payment method,and proposes that different payment methods will have different medical expenses.Secondly,this paper takes the medical insurance payment method of Guilin as an example,and elaborates the reform background and payment method of medical insurance payment methods in Guilin.Before the new medical reform in Guilin City,the post-payment medical insurance payment method based on project payment was mainly adopted.After the new medical reform,it became a way of paying a variety of payment methods based on the total budget.Although Guilin City adopts the prepayment system of “total budget” in form,the post-payment system represented by payment of service items is still the main payment method,and multiple payment methods coexist.Through an in-depth analysis of the current income and expenditure of medical insurance funds in Guilin City,it can be found that although Guilin City has achieved certain effects in the control of medical expenses through the reform of medical insurance payment methods,the reform is not a one-step process,and the road to reform is long and tortuous.On the reform road,there are problems such as insufficient scientific determination of the total budgetary indicators,difficulty in implementing the disease-based payment methods,and lack of a sound evaluation and supervision system.Based on the medical insurance payment methods of typical countries in Germany,the United States and the United Kingdom,and the domestic Zhenjiang,Shanghai and Beijing models,we can clarify the direction of reform.A single service-based payment method will gradually increase to the total budget.The multi-composite payment method such as paying for the disease,paying by bed,etc.,the prepayment system will replace the post-payment system.The total budget,the DRGs payment method and the case-based payment are the general trends of the reform of the medical insurance payment method in Guilin.Combined with the current situation of reform of medical insurance payment methods in Guilin,this paper puts forward the system design about the reform of basic medical insurance payment methods in Guilin,which mainly includes three aspects: proposing about total budget,DRGs payment method and payment method based on disease type.Program designed,establish performance evaluation mechanism for scientific indicators,and strengthen medical service supervision.Combining theory with practice in the design of the program,using a large number of data and calculation methods to illustrate the reform of payment methods has a strong practical significance and implementability,I hope this article can play a certain role in promoting the reform of medical insurance payment methods in Guilin.