Research On The Choice Of Medical Insurance Payment Methods In China

In recent years,due to factors such as population aging,chronic disease,and expansion of the medical insurance catalog,my country's medical expenses are increasing rapidly.At the same time,the overall economic downturn and the heavier burden on enterprises have also made it difficult for medical insurance financing capacity to continue the previous rapid growth trend.The income growth rate of medical insurance funds has generally declined and the increased rate of fund expenditures has continued to rise.As medical insurance achieves universal coverage,there is little room for the fund to expand and increase revenue.At present,medical reform has entered the deep water zone and the problem of "difficult and expensive medical treatment" still exists.On November 26,2019,President Xi Jinping proposed the establishment of an effective and efficient medical insurance payment mechanism at the 11 th meeting of the Central Comprehensive Deepening Reform Committee.Under this profound background,the choice of medical insurance payment methods has become the key.The medical insurance payment method is cost control,standardizing and guiding the provider's medical service behavior,the demander's medical treatment behavior,and an important lever to adjust the allocation of medical resources.It is related to the smooth operation of medical insurance and directly affects the quality of medical services of medical institutions.It can affect the patient's medical expenses level,the management cost of medical insurance institutions,and many other aspects.It can be said that it is the most direct and sensitive link in medical insurance that involves the economic interests of all parties.Therefore,it is of great practical significance to choose which medical insurance payment method to make the expenditure of my country's medical insurance fund more scientific,reasonable,and accurate.This article first explains the reasons for the medical insurance payment method from the perspective of the moral hazard of both the doctor and the patient and analyzes the internal mechanism of the medical insurance payment method affecting the behavior of the medical service provider.Secondly,by analyzing the behavioral characteristics of the supply and demand parties and the payer in the medical service market,using game theory methods,construct a repeated game model of the hospital,the insured patient,and the medical insurance institution under the condition ofasymmetric information.When the hospital has the moral hazard of excessive medical treatment,excessive charging,insufficient diagnosis and treatment,and improper charging,the strategic choices of insured patients and medical insurance institutions are discussed separately.The optimal payment level and its determinants of the medical insurance institution to the hospital are studied when the medical insurance institution adopts the pre-payment system and the post-payment system.The results show that the prepayment system represented by the diagnosis-related group(Diagnosis Related Groups,DRGs)is better than the post-payment system.This paper takes the implementation of DRG payment in Beijing as an example and uses the double-difference method to measure the regression model to compare the implementation effects of DRG payment and single-disease payment in terms of medical expenses and medical quality.By analyzing the impact of DRG payment on the behavior of relevant stakeholders of medical insurance payment methods,including medical institutions,medical staff,insured patients,and medical insurance institutions,it is further verified that the prepayment system represented by DRG payment can be used as a payment method for my country's medical insurance.prior choice.Based on the experience and practices of foreign countries implementing the DRG prepayment system,combined with the specific national conditions of our country,we put forward specific policy recommendations for the implementation of the prepayment system represented by DRG payment in our country.The main conclusions of this article are three points: First,under the prepayment system,if the hospital is to adopt an honest strategy,the medical insurance institution cannot reduce the pricing to the average cost but should enable the hospital to generate positive incentives through profit.Second,when the hospital does not pay attention to future benefits or the difference in treatment costs is large enough,the post-payment system will be better than the pre-payment system,otherwise,the pre-payment system will be better than the post-payment system.Third,the cost control effect of the DRG payment method is obvious,but compared with the decline in the DRG medical insurance fixed payment standard,the actual medical cost decline is relatively small.The innovations of this paper are as follows: First,the pre-payment system represented by DRG payment is obtained as the precondition that the pre-payment system is better than the post-payment system.Using the method of game theory,arepeated game model of medical insurance institutions,patients,and hospitals under asymmetric information is constructed.Under the condition that the hospital pays attention to the future benefits and the cost difference of different treatment methods is not big,the prepayment system represented by DRG payment is better than the post-payment system.The second is to propose that my country's medical insurance payment mechanism requires the establishment and improvement of related supporting systems.The double-difference method is used to evaluate the implementation effect of DRG payment in Beijing.The results show that although DRG payment has achieved significant cost reduction effects during the implementation process,the reduction in actual medical expenses is less than that of the DRG medical insurance fixed payment standard.Small,it also needs the establishment and improvement of other supporting systems.The third is to include the sub-system of the DRG prepayment system implementation into the management and control of the comprehensive system engineering of medical insurance payment.The reform of the payment method based on the DRG prepayment system is a complex system engineering.The subsystems implemented by the narrow DRG prepayment system should be incorporated into the cost payment and control of system engineering such as large-scale procurement and medical consumables pricing in a broad sense.