Medical Aid Cost Control Mechanism Study Based On Community Health Service

Objective On the basis of qualitative and quantitative, this study aimed at understanding the forthputting of medical aid and the operation of fixed-point medical institutions about UHPP two projects Xining, Yinchuan, appraising the medical aid cost control measures of the two cities, make use of Strategy Analysis to analyze medical assistance costs control measures. Combination of literature analysis, made the route choice on the control mode of medical assistance expenses in the situation of our country, provided decision to the government relevant departments, ultimately gain the ends to increasing efficiency in the use of poverty relief funds, and improving the social medical assistance system of our country.Method Date collection:The study used the literature, qualitative and quantitative. The literature used official website, foreign language databases, China HowNet database. The interviews mainly used in-depth interviews and personal interviews. For different target, the researchers developed an interview outline, mainly involved in the allocation and forthputting of funds; Medicaid cost-control measures, the effect and the problem; Different departments for the evaluation of the implementation of the project. According to the outline, useing of personal-depth interviews to collect information from project office, assistance office, civil affairs departments, social security departments, health authorities, community health services, medical assistance to the focus group interviews conducted. Quantitative survey mainly including existing data collection:First, collecting relevant information of the official publication; Second, collecting project data and the baseline survey report, operation analysis of the annual report, community health service agencies to provide the number, type, cost of medical services.Data analysis:The quantitative data are mainly descriptive analysis; The qualitative data have been recorded by reading the text, coding, classification, qualitative analysis to explain a series of steps to interpret the information and use triangulation methods analyze the reliability and validity. Using SWOT analysis, strategy analysis and interest group analysis to carry out a comprehensive analysis.Results Make use of Descriptive Analysis analyze the forthputting of medical aid and the operation of fixed-point medical institutions about Xining, Yinchuan, It is show low utilization of funds, the relief program has higher level of adjustment in the space; Through the implementation of the project, promoting the community health services in institutional capacity-building.Appraising the medical aid cost control measures of the two cities:establishing the object of medical aid targeting mechanism, carrying out dynamic management; Relief programs in both coveraging public such as preventive health care; Outpatient and inpatient services with a certain pay line, the proportion of total pay and capping line, restricting rescue object excessive use; Selecting the community health service as the main service providers, strictly carrying out first treatment and double-direction transfer reference; developinf the relevant directory, reforming and improving the payment system, matter in the implementation of relief, strengthing the control of supply-side; Explorating the reform of community health service agencies operating mechanism, Perfecting compensation channel, establishing the parity health care system, day-to-day monitoring and evaluation stage, combinating of expert assessments, management and supervision system in place; Establishing the Clearing Network of fixed-point medical institutions and information management system of community health services.Problems:Absolutly lacking of financing and the coexistence of a relative surplus of funds, limiting the accessibility of health services; There are still some loopholes in locking target population, causing the resources spill-over; Some aspects is missing of public health services and chronic diseases management, the quality need to further improving; The behavior clinic of doctors need to be strengthened; The double-direction transfer reference is ineffective; Patient services payment is still old, It is not conducive to control over supply-side supply; Separation of revenue and expenditure management policy is still in the planning stage, the effect has not yet been given full play.Exploring the route choice on the control mode of medical assistance expenses in the situation of our country:Under the real condition, we should accelerate the establishment of a two-way referral new urban medical service systems with a reasonable division of labor, which cooperate closely and complementally, building a grass-roots community which based on health services as platform, improving the management system and compensation mechanism of community health services gradually, basing on urban medical aid and community health service management information technology systems, learning from advanced international concepts of medical assistance cost control model was seen as a rational choice. Based on this study, we give countermeasures and suggestions form the macro and micro aspects, in order to provide basis for relevant departments'decision making.In this study, the above model in the real environment as follows virtuous path to run the design:With government support, making full use of community supervision, according to the availability of funds, with medical assistance management information system and other technology, acting on the supply of medical aid service centers system which is a reasonable division, double-direction transfer, in order to control cost mainly, both protect the quality and promote equity, improve the satisfaction, summing up as "one center, two main, two kinds of means." Conditions covered by fund-raising support, government support, community supervision, and institution-building, technology platform.