Study On The Mechanism Of The Impact Of Disease-based Payment Reform On Medical Expenses In Public Hospitals Of Youxi County,Fujian Province

Objective:To analyze the mechanism of the impact of disease-based payment reform on medical expenses in Youxi County.And to summarize the practical experience and problems in the implementation process and put forward corresponding suggestions.Contents:1.The background environment for the implementation of disease-based payment reform in Youxi County.2.The policy measures and current status of disease-based payment reform in Youxi County.3.The mechanism analysis of the impact of disease-based payment on medical expenses in public hospitals of Youxi County.4.Changes in medical expenses after disease-based payment reform in public hospitals in Youxi County.5.Summarize the practical experience of disease-based payment reform in Youxi County public hospital and analyze the existing problems.Methods:This study used literature research to sort out the concepts and theories of disease-based payment and medical expenses.Then this study conducts on-the-spot investigation in Youxi County,issues self-filled questionnaires to relevant directors of medical reform office and public hospitals and interviews with insiders.Based on the theoretical framework of CIMO,analyzes the background,measures,mechanisms and results of disease-based payment reform in public hospitals in Youxi County,and uses system dynamics causality diagrams to analyze the related influencing factors of medical expenses and the effect of disease-based payment reform on medical expenses mechanism.Results:1.Disease-based payment reform plays an incentive and restrictive role in the medical behavior of medical service providers.Hospitals control the rise of medical expenses through the relevant strategies of clinical pathway management,and doctors control the excessive increase of average secondary medical expenses through reasonable diagnosis and treatment,reducing the induced demand behavior.2.After the reform,the growth rate of medical expenses decreased.The growth rate of second-time average medical expenses and patient-paid medical expenses slowed down.The effectiveness of medical expenses control was obvious.The hospital income structure was optimized,and the operation of medical insurance fund was stable.Conclusions:Youxi County implements disease-based payment reform.Through the incentive mechanism of medical insurance fund allocation and performance appraisal,it stimulates hospitals’ willingness to control medical expenses and doctors’ awareness of controlling medical expenses,which plays a key role in controlling medical expenses.Recommendations:1.Formulate scientific and reasonable medical insurance payment standards.2.Strengthen the supervision of the medical insurance department and improve the hospital monitoring system.3.Increase the proportion of medical insurance reimbursement,and effectively reduce the burden of patients’ medical treatment.4.Strengthen hospital information construction.5.Continue to promote the disease-based payment reform.