| Objective:In order to protect the legitimate rights and interests of insured persons,improve the use efficiency of medical insurance fund and ensure the smooth operation of the fund,W City carried out the value orientation of Dignosis-Intervation Packet,which has been for 7 years.In order to analyze the implementation effect of the value orientation of Dignosis-Intervation Packet in W City,and put forward corresponding optimization countermeasures for possible problems,this effect evaluation was carried out.Methods:Based on the full discussion of the project group and the operability of literature review and data acquisition,the evaluation was planned to be implemented from 4dimensions:the total budget and change trend,the expenditure and structure of medical insurance fund,the hospitalization rate and the flow of hospitalization services,and the degree of institutional advancement.In addition,in the form of quantitative questionnaire,the relevant statistical data from 2015 to 2019 were collected from the medical insurance information system management platform of W City by means of the program set by engineers.The target covered all designated medical institutions that carried out the Dignosis-Intervation Packet,and analyzed the survey data with SPSS 25.0.Results:（1）From 2015 to 2019,the proportion of the annual budget of DiagnosisIntervation Packet in the total financing of employee medical insurance decreased form50.4% to 45.7%;the unit price of points increased from 0.39 yuan in 2015 to 0.51 yuan in2019,and the unit price is generally low;（2）the annual actual expenditure of employee medical insurance fund accounted for between 67.5% and 79.0% of the total amount of fiancing,the proportion of medical and health institutions in the city in the actual medical insurance expenditure of employees remained at a high level（84.8%-89.6%）;and the difference between the total budget and the actual expenditure of Diagnosis-Intervation Packet in each year is between 136.42-258711 million yuan,the balance is on the rise,the fund stock is larger.In the past five years,the total paid expenditure of DignosisIntervation Packet accounted for between 56.7% and 68.4% of the total expenditure of medical insurance funds,and the former to the total municipal expenditure of the medical insurance fund was also maintained between 66.9% and 77.8%,and more than 90% of the total amount of Dignosis-Intervation Packet was paid to tertiary hospitals.（3）The annual hospitalization rate of employee medical insurance decreased from 18.4% to 15.7%,and the hospitalization service decreased significantly;the proportion of hospitalization in city remained above 90%,and the proportion of inpatients in tertiary hospitals who carried out Diagnosis-Intervation Packet was as high as 82.9%-86.0%;at the same time,the proportion of hospitalization in the city of several major diseases which the number of the hospitalizations was high was between 99.3% and 99.8%,and taking coronary atherosclerotic heart disease as an example,the treatment is mainly concentrated in tertiary hospitals.（4）The number of cases in hospitalization in city which is settled by Dignosis-Intervation Packet was kept at about 98%;from the perspective of the total score distribution of diseases,the score of tertiary hospitals accounted for 84.1%-90.6% in the five years,and the average score of tertiary hospitals was relatively stable,and the average score of other medical institutions at all levels showed a downward trend.The number of special cases,the proportion of the number of special cases in the total number of settlement,and the proportion of the scores of special cases in the total score of settlement all showed a trend of declining first and then rising.Conclusions:The value orientation of Dignosis-Intervation Packet in W city has achieved some results:（1）The fund achieved balance of revenue and expenditure,and the effect of fee control was obvious;（2）The annual hospitalization rate decreased significantly,which has restrained the unreasonable growth of hospitalization services to a certain extent;（3）The hospitalization rate in the city has always remained at a high level,and the medical level in the city can meet the daily diagnosis and treatment of insured patients.There is still much room for policy optimization:（1）The total budget is lack of fine design and dynamic adjustment;（2）The classification of diseases and the setting of the score is lack of scientific and reasonable,can not reflect the actual value of the disease;（3）The utilization rate of medical insurance fund needs to be further improved;（4）There is a large gap in the settlement coefficient of medical institutions,and hierarchical medical ssystem need to be further promoted.Suggestions:（1）improve the utilization rate of the fund,optimize the total budget and formulate a dynamic adjustment mechanism;（2）Refine disease grouping to reflect the value of disease;（3）Adjust the settlement coefficient of institutions and promote the implementation of hierarchical medical ssystem;（4）Scientifically consider the formulation of quality evaluation system and improve the supervision and incentive mechanism. |
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