Research On Medical Insurance Negotiation Mechanism Under The Model Of Diagnosis Related Groups

Based on the analysis of the necessity and feasibility of constructing a medical insurance negotiation mechanism under the diagnosis related groups payment model,the research comprehensively apply multi-disciplinary theoretical systems and methods such as social security,management,and economics.Drawing on the practical experience of relevant areas at home and abroad.Innovatively put forward countermeasures and suggestions for medical insurance negotiations under the diagnosis related groups payment model.The research is divided into six parts.The first part is the introduction,focusing on the research background,objectives,significance,content,methods and research review;The second part is the definition of the concept and the brief introduction of the theoretical basis;The third part is to analyze the necessity and feasibility of establishing health insurance negotiation under the diagnosis related groups payment model.The first is to analyze the necessity from three aspects: medical expense control,medical service quality management and transformation of medical institutions;the second is to analyze the feasibility from three aspects:medical insurance management ability,medical insurance function integration and management ability of medical institutions;The fourth part discusses the experience and enlightenment of medical insurance negotiation under DRGs payment mode at home and abroad.Four regions,Xixian,Tianjin,Lianyungang and Shenzhen,were selected to carry out the research.Overseas research focuses on the United States,Germany and the United Kingdom;The fifth part is to study the construction of the medical insurance negotiation mechanism under the diagnosis related groups payment model;The sixth part,from the three dimensions of government,medical insurance agencies and medical institutions,puts forward countermeasures and suggestions to improve the medical insurance negotiation mechanism under the diagnosis related groups payment model.