Research Of The Payment System On Community Health Service

Objective: Based on reviewing the community health service payment types in international and national, the roles and impact of payment system was analyzed, to improve the needs for payment on community health services. Analyze the experience of community health services payment in representation countries and some typical areas in China, exploring the payment model, characteristics and problems of supply-side and demand- side at present, and put forward the suggestions on the payment of the community health services that suitable to China's national conditions. Propose the optional program on the community health payment to set up basic medical and health system for 2020.Methods: The comparative analysis by means of the literature study to community health service at home and abroad used, and the payment types, the roles and impact of their experiences, characteristics and the existing problems analyzed and summarized; the empirical research to analyze the payment status, characteristics, implementation of results, the problems and the impact of the performance of health services of urban community health service centers for the supply-side payment and demand-side reviewed; the data on 5??mmunity health service centers and the centers of Department of Fund and Information Management on Basic Health Insurance in Dalian was collected, and quantitative analysis of the cost carried out.Results: The community health service in urban area is a new way in health service system of the foundation to provide the public health services and basic medical services with safety, effective, convenient and economical to the residents. In order to solve the problem of"Difficult for seeking care, Costly for seeking care", it is necessary to reform the payment methods for adopting more feasible way to community health services. Community health service payment reforms have positive significance on facilitating medical treatment for the insurance, controlling the health care cost, reducing the cost of insurance personnel, and improving the use of efficiency of medical insurance fund.Payment systems of health services directly affect the behavior both supply-side and demand-side, and have a clear direction or constrain role of health reform on the cost control, resource allocation, quality of service, efficiency and fairness in the process of health service. Different methods of payment result in different incentive mechanisms to providers and consumers, so health care services with related parties have different effects on behavior, resulting in different economic and resource flow con- sequences.The existing payment system of supply-side cost of medical insurance internationally are of mainly two types that are prospective payment and retrospective payment system. Retrospective payment includes Fee for service payment, while the prospective payment includes the pay for unit, capitation, DRG, global budget, salary and pay for performance. Payment system of Demand-side cost of medical insurance include deductible, co- payment, limits and maximum and mixed-payment. Different payment methods have different advantages and disadvantages. Various payment methods in different medical insurance system came into being for different purposes, and any kind of payment methods are both positive and negative, and also are different in the implementation of the operation.The medical expenditures of chronic disease for each insured person in the community health center in Dalian is less than those of the second and the third-level hospitals, while the proportion of managed fund is higher than the second, the third-level hospitals. The per capita and the proportion of OOP decreased. But the health finance by input government to the community health service center accounted for a relatively small share, and the medical and pharmaceutical revenue were main source of finance.For payment system reforms of the demand-side, achieve at the objective that Government purchasing health services, reducing the de- ductible and co-payment, increasing the limits and maximum, giving the subsidies to demand-side. For payment system reforms of the supply-side, implement Capitation and Global budget, combined with Pay for case. For community health service providers, implement Capitation and pay for performance.Conclusion: Community Health Service is an effective way to solve the problems of"Difficult for seeking care, Costly for seeking care". While the one point of the problems is the payment system. A good way to pay medical costs not only to control the growth within a reasonable range, while to improve service efficiency for health service institutions, to reduce demand-induced, to meet the needs of the health services for demand-side for achieving universal coverage, and to reduce the moral risks in order to develop health insurance with medical services healthy and coordinated. A single payment system of community health services can not meet the needs of all consumers, providers and the patient at the same time, so it should reform payment with supply-side and demand-side at the same time. Then, play the role of community health service as the"gatekeeper"in order to resolve the tough problems.