Study On The Payment Reform Of Residents’ Medical Insurance System In Jilin Province

Residents’ basic medical insurance system is designed to share the economic losscaused by the risk of disease. The insured person’s medical expenses engendered bytaking medical care are paid by medical insurance. At the same time, a paymentrelationship is built up between the insured person and the medical insurance provider;that is to say, payment is the most direct and sensitive link of medical insurance systemas well as a main factor influencing medical insurance system’s different aspects ofbehavior. Therefore, the reform, perfection and combination of payment pattern havebecome the key to the stable and sustainable development of medical insurance system.Countries all around the world, including China, have explored various payment patternsof medical insurance system and formed their own characteristics. The in-depthdevelopment and exploration of medical insurance system’s payment pattern is of greatsignificance.This paper first introduces the background of international and domestic medicalexpenses’ rapid increase, pointing out medical expenses’ unceasing growing proportionin each country’s GDP all across the world. Also, medical cost per capita is alsoincreasing, giving rise to heavy pressure which cannot be ignored to national finance.This part lays a theoretical foundation for later research through the analysis of medicalinsurance system payment pattern’s definition; and by the analysis of different paymentpatterns’ characteristics and implementation conditions. Next, this paper discusses thepayment pattern practice of foreign residents’ basic medical insurance system byintroducing typical payment patterns such as Singapore’s personal savings account,DRGs in the United States and Japan’s DPC. It further summarizes the reformachievements of residents’ basic medical insurance system payment pattern in China’sZhenjiang City, Mudanjiang City, Lufeng Town in Yunnan Province. This paper stressesthe enlightenments to China’s payment pattern reform in residents’ basic medicalinsurance system brought by external and domestic reform experiences; and finally goingback to the reform practice in Jilin Province. It suggests the current status of paymentpattern in Jilin residents’ basic medical insurance system, Jilin new rural cooperativemedical insurance’s payment situation as well as its typical and special payment patternin the practice; concluding3main problems existing in the usage and practice of Jilinresidents’ basic medical insurance payment and proposing that the payment pattern isn’tin accordance with the specific local conditions, medical agency’s passive position in thewhole process of payment haven’t been reversed, medical agency’s managing ability is limited and payment pattern’s internal mechanism is lack of supervisory and restrictiveclauses. This paper puts forwards a couple of suggestions such as exploring a combinedpayment pattern that gives priority to PPS, strictly implementing flexible payment whichkeeps the rules for reward and punishment, perfecting negotiation mechanism, raising thedegree of centralized payment and managing level, improving the medical informationsharing platform.