Empirical Research On Provider Payment Reform

Health insurance is a key tool to improve public health which is the basis of comprehensive well-off.It has progressed to delicacy management from expanding the coverage of the basic medical insurance in China.As an economic leverage to balance health service quantity and quality,provider payment method has been the one of the most important policies.Choosing a scientific and reasonable payment method is a key way to optimize the allocation of medical insurance funds,protect people’s health outcome and control medical expenses.It is also an important guarantee for achieving refined management of medical insurance and enhancing the public’s sense of access to health services,happiness,and security.This study expanded the classical theoretical model of impact of provider payment on physicians’ and patients’ behavior and finally on health outcome as well as costs.And then,typical payment reforms in Tianjin were assessed.In the assessment of casebased payment for angina/ acute myocardial infarction stent implantation patients based on claim data,it was found that the reform was associated with significant increased demand and decreased costs,but had insignificant effect on health outcome.In the evaluation of capitation for diabetes based on registry and claim data,the policy was proved to help optimizing the process of care but no influence on health outcome and costs.In the evaluation of capitation for hepatitis C,prediction model based on Markov model was constructed and shows the reform would increase cured patients and reduce death as well as costs for the whole society.Based on theses results,recommendations including improving incentive system of healthcare providers and physicians,enhancing insurance sophisticated management and compatibility of different payment methods,promoting the trial reforms to the whole population as well as improving collaborative management of multiple departments were raised.