Study On Capitation Payment Of Outpatient Co-ordination

In recent years, the rapid rise in medical costs is a common problem for the countries of the world. The voice of the way to improve the payment of medical insurance is increasingly intense. The ability to control the use of capital has become an important area of medical insurance system research. This also becomes the inherent driving force of the adjustment of system contents and technology arrangement. The control effect of medical insurance payment is stronger. This is mainly due to the payment method itself has the economic function of the decision. The change of the operating environment of the medical industry brought by the adjustment of the system is the need of the risk management for the medical insurance fund and the objective need of the system itself. The majority of countries in the world generally by adjusting the payment range of Medicare fund, changing the way to pay the way to control medical expenses. In a new round of medical and health system reform, the government has become more aware of relying solely on the health care financing quantity increase, unable to meet the increasing demand for health services and normal medical market system construction must be under the premise of strengthening the leading role of the market economy, increasing the intensity of policy intervention.Medical insurance payment is the key link in the process of medical insurance system.. Medical insurance fund may be at risk of multiple financing, operation and payment, which paid the biggest risk, payment management is medical insurance system smoothly running the indispensable condition, so the Medicare payment system risk prevention is also very important and of medical service supplier payment behavior is the Medicare burden of medical expenses and resist illness risk effect of an important guarantee, so pay different ways of medical expenses spending limits, the method for allocation of medical resources and patient can enjoy the service quality will change. The payment method is related to the vital rights and interests of the main body, and it has a huge impact on health insurance, so it is necessary and meaningful to study the way of paying.In order to comprehensively promote the outpatient co-ordination, "on further promoting medical insurance payment reform opinions" (Ministry of human resources and social [2011] No.63) proposed "the expenses of outpatient medical payments, according to residents outpatient service medical insurance as a whole is generally carried out to adapt to the grassroots medical institutions or general medical students the establishment of the first diagnosis system, to explore the implementation to capitation payment." In the new medical reform program requirements and actively explore ways of paying, the total advance has been throughout the country, according to the disease pay is in full swing to engage in the pilot, but topped the list of capitation payment are rarely used, and even if there are regions of the capitation payment reform exploration, but the reform road struggling, this study aims to based on existing out-patient payment implementation problems encountered in the process, encounter obstacles of reason analysis, provide a reference.This paper is divided into seven chapters, the first chapter is introduction, proposed research background and significance, reviews the research status at home and abroad, research purpose and content, methods and paths, and puts forward the innovation points and deficiencies; second chapter of outpatient co-ordination of capitation payment way to define the related concepts and theoretical basis of analysis in this research, on this basis, explores this problem; The third chapter analyzes the Chinese outpatient coordinating payment under the policy of medical insurance payment, some key problems, including the basic characteristics of outpatient coordinating payment policy paper, then pay for the existing major suppliers of medical insurance was introduced and the advantages and disadvantages of different payment methods are compared and analyzed, at the same time also may use the mixed payment the exploratory analysis model; The fourth chapter is on the China outpatient co-ordinate the capitation way thoroughly analyzed the present situation, first of all from the existing policy documents to the outpatient co-ordinate capitation payment policy status quo, then select the payment reform implementation and analysis of the typical area of experience and lack of the line in the process of, Finally, the payment reform, reform has the intention of empirical analysis of several conditions and effect of the reform, this study combined with relevant data collected earlier investigation of outpatient co-ordination, in conjunction with the payment way of qualitative and quantitative analysis according to the number of people on the basis of the comprehensive analysis, in-depth on the implementation status; The fifth chapter based on the outpatient co-ordinate capitation in implementation issues are given specific design scheme of capitation way, then based on the macro perspective, combined with the lack of barriers to the implementation of payment itself and in the internal and external mechanism required in the implementation of this Chinese supplier payment; The sixth chapter analyzes the specific practices of foreign typical countries of outpatient co-ordination capitation way, through the analysis of the background, development and existing conditions, to explore the experience in the process of practice as a useful reference for future implementation of Chinese this payment method; The seventh chapter is a conclusion based on the review of the previous studies, and the China outpatient co-ordinate the capitation approach put forward policy recommendations, to ensure the payment of policy science, reasonable, taking into account the interests of the insured patients, medical services and medical insurance Department of the three party, and ultimately enhance the efficiency of the medical insurance fund, to optimize the use of medical resources and the constraints of the irrational increase of medical expenses.