Experimental Research On Treatment Payment Reform

Objective One is on theory , explore to establish effective medical expenses and health insurance pay way,and explore practicable operation mechanism of payment system . Second is on practice, depth analysis different payment system reform plans of three experimental research areas , horizontal and longitudinal compare three reforms'initial results on prompting the government to increase investment, hospitals and medical personnel consciously controlling cost and residents having a rational choice about drugs. Three is on the application of the achievements, summarize payment system reform experience and provide referent basis and alternative solutions for other areas.Methods This research used the quantitative and qualitative research methods to make horizontal and longitudinal comparison to the effect of global prospective payment, outpatient payment by visit and inpatient delivery quota payment through agency survey, resident survey and interview with the relevant personal. The major indicators included outpatient cost per visit, doctors'prescribe behavior, Residents'health service utilization,satisfaction degree. We made descriptive analysis, t test and chi-square test using SPSS16.0 statistical software.Results 1.Outpatient payment by visit in Binhai district: (1) System Design: to determine the number of visits per capita each year and outpatient cost per visit; to determine the outpatient financing programs annually; to design the outpatient services package; to make the payment program; to design the evaluation criteria and assessment system. (2) Effect Analysis: Outpatient cost per visit dropped, below the average level of Weifang (P<0.01); rural medical institutions behavior change, the quantity of drug used per description decreased (P<0.05); residents'benefited range is expanded; various interest groups had high degree of satisfaction. 2. Inpatient delivery quota payment in Qingzhou: (1) System Design: designated hospital; quota payment. (2) Effect Analysis: the rate of cesarean section in designated hospital rate is down (P<0.01); average hospitalization cost is reduced (P<0.01); the rate of maternal mortality and neonatal mortality has no change. 3. Global prospective payment of NRCMS in Shouguang: (1) System Design: scientific formulation NRCMS total fund, instant submits an expense account. (2) Effect Analysis: outpatient cost per visit, hospitalization cost per visit and compensation fees per visit are all down (P<0.05); hospital compensation has improved, unreasonable hospital services is reduced (P<0.05).Conclusion Payment reform, can effectively reduce the medical expenses; to be able to alleviate the problem of insufficient medical institution compensation; to construct a scientific and high-effective price supervision mechanism; conducive to changing the medical service behavior; is expected to promote medical health system reform.