Volume 7, Issue 2, March 2019, Page: 53-58
Using the Method of Medical Insurance Payment Reform to Promote the Path Selection of Large Hospital Development
Pengyu Xu, School of Business Administration, Andrews University, Berrien Springs, USA
Received: Apr. 19, 2019;       Published: May 23, 2019
DOI: 10.11648/j.sjph.20190702.14      View  117      Downloads  23
Abstract
At the beginning of the establishment of the basic medical insurance system in China, the primary implementation was a single project-based payment. At present, it has gradually explored a single or mixed way to pay, mainly including payment by disease type, payment by the number of people, payment by medical service unit and payment by the DRGs (Diagnosis Related Group System). This paper discusses the reform of payment mode of basic medical insurance in large hospitals and summarizes the main features of the reform of the payment mode of basic medical insurance in the past. First of all, the basic medical insurance management department has absolute choice and pricing power. The government is responsible for the management of basic medical insurance, and the hospital is in a state of passive implementation of government policies. In addition, the reasonable demands of large hospitals can hardly be effectively reflected in the policy. Last but not least, the improvement of hospital serviceability and the promotion of patients' reasonable medical treatment effect have not been realized effectively. The research results of this paper mainly discuss the reform path of basic medical insurance payment methods in large hospitals. For one thing, large hospitals can proactively report to the basic medical insurance management department the reformed disease types and disease charges for basic medical insurance payments. For another thing, the large hospitals can determine the diagnosis and treatment plan of the disease according to the clinical path of disease diagnosis and treatment. The basic medical insurance management department can explore the new path method of reforming the basic medical insurance payment method in large hospitals according to the reform idea of “the same disease insurance standards are consistent” and individual “differentiated self-payment." At the same time, it is recommended that the government use the professional management ability of commercial insurance companies to improve the performance of basic medical insurance by purchasing commercial insurance company services. Give play to the third-party role of commercial insurance companies to help alleviate the asymmetry of the hospital and patient medical information and the contradiction between doctors and patients.
Keywords
Large Hospitals, Reform of Medical Insurance Payment Methods, Differentiated Self-Payment, The Same Disease Insurance Standards Are Consistent, Basic Medical Insurance Management Department, Reform of Medical and Health System
To cite this article
Pengyu Xu, Using the Method of Medical Insurance Payment Reform to Promote the Path Selection of Large Hospital Development, Science Journal of Public Health. Vol. 7, No. 2, 2019, pp. 53-58. doi: 10.11648/j.sjph.20190702.14
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