Medicare Prepayment Medical Model Of Tertiary Hospitals In Shanghai

Medical insurance payment is a very important role to regulate the allocation of medical resources, Which having decisive influence on hospitals and the insured. Therefore, finding a scientific and reasonable way to payment is a key point to achieve managing medical insurance.The perspective system as a method of payment, have been very popular in other countries. The perspective system which have been implemented in the leading hospitals in Shanghai, is a mixed payment pattern, including total prepaid amount system, DRGs-based payment system, DRGs-PPS, and so on.Combined with the macro and micro realities, as well as national and international conditions, and predominated the principle of using qualitative and quantitative analysis together, the research adopts following methods, such as literature survey, comparative study, depth interviews, small seminars, SWOT analysis and so on. Took Zhongshan Hospital of Fudan University as a sample to study the changes of medical practice pattern under prospective payment system of medical insurance, we finally get following conclusions in three dimensions. Firstly, to the administration of medical insurance fund, the perspective payment system is benefit to control the income balance of medical insurance fund, as well as avoiding fund-strand breaks due to other payment terms. Secondly, to the hospitals, considering the development strategies and tactics, the perspective system directly affects the doctors' medical behavior, as well as the assessment indicators, consequently to improve the utilization of medical resources. But the perspective system will induce some negative phenomenon for hospitals'own interests, such as reducing the costs deliberately and selecting patients. So the strengthened supervision is required to the hospitals. Finally, to the patients, the perspective system will effectively control the costs of the outpatients and inpatients to reduce the patients' medical burden. Correspondingly, the proportion of self-paid will be increased, according with the increase of doctor visiting.Drawing on the related experience overseas, also with some domestic cities which implementing the prospective payment currently, this research proposes some comments and suggestions to the perspective payment system of medical insurance in Shanghai.1.Continue to consummate the total prepaid amount system.2.According to the overall situation of the current medical reform, to establish the supporting measures which complied to payment system.3.To set up the commonwealth in different hospitals.4.To implement the clinical pathways.5. Take successful experiences of the prepaid system of other countries to improve the administration of the perspective payment system in Shanghai.6.To development private hospitals and replenish commercial health insurance decently. All of these practical suggestions wish to be helpful for the relevant government departments to make decisions when achieving the perspective payment system of medical insurance.