Our Medical Services And Insurance Negotiations

Objective:To propose the primary framework of Chinese negotiation system between hospitals and health insurance departments according to the theoretical analysis of medical negotiation for health insurance and the reality of development of Chinese health insurance system.Methods:in this study,.the author mainly uses literature study by reviewing a large number of documents both in China and abroad, and references views of experts in this field.Results:(1) In this study, the author starts with theoretical analysis of health care economics. It analyses the root causes of market mechanism failures and theoretically explores the necessity, conditions and the Advantages for the health insurance sectors and medical institutions to negotiate the price of medical services. The study suggests that the underlying causes of negotiation mechanism is the asymmetric information caused by the principal-agent relationship, patients'insensitiveness to medical price under health insurance payment and monopolistic market status of health insurance sectors in the universal social insurance system. The conflict of interests is the primary condition for negotiation, and the balance of bargaining power and consensus standards are the two key factors to achieve the purpose of the negotiations.(2) The author makes a detailed analysis of the development of Chinese health insurance system, the pricing means and results to fully understand China's environment in reality. The results show that our universal health care system has taken shape, the health care financing, reimbursement and ability to pay rising health care sector has formed a strong purchasing power and bargaining power. However, the current government price departments'direct control of medical service prices in the new items led to the introduction of medical institutions in a higher price paid by health insurance sectors who is the weak side in a passive position; and health insurance sectors control the paying standards through catalogs, service agreements or other payment methods which leaves medical institutions at a disadvantage. Therefore, the current pricing to some extent results in the formation of power imbalance between the buyers and sellers.(3) According to the theoretical analysis and the reality of Chinese health insurance situations, the study analyses the conditions for establishing negotiation mechanism one by one, at the same time learns from foreign countries'experiences, and proposes the primary framework of Chinese negotiation system. This study suggests that the negotiation can be set up at the provincial level, and it is necessary to establish a coordination agency under the province Development and Reform Commission. The agency includes permanent working groups, expert groups and consulting groups and it should be nonprofessional and full-funded. The agency is responsible for evaluation and coordination, and the results will the important basis for negotiations and will be submitted to the provincial price administration departments and health care political government.