GuangZhou Designated Medical Institutions According To Evaluating Payment By Disease Scores Implementation Effect Evaluation

Payment by disease score under total amount control is one of the most scientific reimbursement methods of medical expenses,which has attracted much attention and is an important part of the payment method of basic medical insurance.In 2018,guangdong province entered into the comprehensive implementation of the pay-per-disease basic medical insurance payment policy,bringing the reform of the payment method of basic medical insurance to a new stage.Under the guidance of the experience of many cities in the province after carrying out some pilot projects,they started the further exploration of the mode of payment by disease score.The administrative departments and agencies of medical insurance have formulated reimbursement systems and matching settlement methods in line with local conditions after assessing the actual situation of financing and use of medical insurance funds.And carry out unified supervision and management by implementing service agreement on designated medical institutions.At the same time,we will continue to improve the fee settlement system and the construction of the control mechanism to control the growth of unreasonable fees.To supervise the reasonable diagnosis and treatment of medical personnel,promote medical institutions to improve the quality of medical services,and economize and rationally allocate medical resources.We will regulate and control the medical insurance fund to ensure its safety and maintain the sustained and steady development of the medical insurance industry.Guided by the theory of social insurance and the theory of public policy evaluation,this paper aims to study the implementation of the policy of payment by disease score in the designated medical institutions in guangzhou,so as to analyze and evaluate the implementation effect.Research contents include:(1)investigate and analyze the implementation of the policy system of payment by disease score in designated medical institutions in Guangzhou;(2)taking a three-level designated medical institution in guangzhou city as an example,this paper analyzes the implementation of the policy of payment by disease score in designated medical institution;(3)to evaluate the implementation effect of the policy of payment by disease score in designated medical institutions in guangzhou;(4)analyze the current problems in guangzhou's policy of paying by disease score,and consider and put forward some countermeasures and Suggestions.Through this study,I have learned that the designated medical institutions in guangzhou have controlled the growth of unreasonable medical expenses after the implementation of the policy of payment according to the score of diseases.To some extent,it reduces the medical financial burden of the insured.The medical insurance management of designated medical institutions has been improved.Medical personnel have changed their work ideas and actively carried out cost management and cost management.Through a series of practical work to implement the policy,the excess pressure of hospitalization expenses in most designated medical institutions can be alleviated or even saved.However,the policy still has some unreasonable and need to be improved,such as unreasonable score setting,inadequate evaluation of basic data.According to the analysis results,thinking and making feasible countermeasures and Suggestions: In terms of the medical insurance administrative departments,they should reasonably adjust the score table and constantly improve the settlement method and compensation method.In the aspect of designated medical institutions,we will strengthen the fine management of medical insurance,improve the ability of intelligent auditing and the construction of information systems,and improve the level of professional technology,quality management and medical insurance services.In the insured,strengthen policy publicity and medical treatment on demand.The parties jointly explore the scientific,rational and clinical applicability of the policy to better promote the effective use of the medical insurance fund.The results of this study can provide a reference for the reform of the payment method of medical insurance and the improvement of the payment policy according to the disease category,so as to achieve the purpose of standardizing reasonable diagnosis and treatment,saving medical and health resources and ensuring fund security.