Study On The Mode Of Social Medical Insurance Provider Payment

[Background]Social medical insurance is a special insurance that is established by a country to share the loss arising from personal disease by the hand of compensating for medical expenses, and it's functions, including covering medical costs and resisting disease risk, are finally realized by paying insurants'medical expenses. So we can say that payment is the most direct and most sensitive aspect linking the benefit of all parties, and is also a main factor that can influence people's behavior. And the most important aspect of cost payment is the behavior of provider payment. There are a variety of provider payment modes and these modes both have their advantages and shortcoming. And some incomplete payment methods are often the main cause of rapid increase in medical costs around the world in recent years. In order to find a payment mode that can both reach insurants'medical need and control medical costs, many regions in China have practiced various payment modes since 1995, and formed their own characteristic.[Objective]First, to collect the research evidence of domestic social medical insurance provider payment modes, and establish a database.Second, to find out the status of payment modes implementation in different regions, compare various payment modes in cost control, service quality, management, and analyze the way of hybrid payment mode.Third, to propose advice for the improvement of payment, which would be referenced by the social medical insurance administration to develop or adjust the payment mode.[Methods]We perform this Systematic Review according to the Cochrane's criteria. Search strategy:A comprehensive search was performed to avoid both bias in the selection of published articles and bias in the language of publications. We used five various databases. Relevant websites and the online resources of relevant international organizations, consultancy firms and academic and research centers were also searched. Selection of studies:The criteria for considering studies in the reviews were applied in two stages. At the primary stage, titles and abstracts of studies were included on the basis of the type of intervention investigated. The second stage inclusion criterion was based on geography:this review included only those studies undertaken in China. Quality assessment:The conclusions of a systematic review depend primarily on the quality of the studies included. Therefore, an assessment of such quality is an integral part of the analytical process. Each study was independently assessed by two reviewers, who would mark the selected literatures. Synthesis:All studies included in this report were categorized into three groups according to their scores:high quality, moderate quality and low quality.[Results]Finally,65 articles are reviewed, of which 5 are from theoretical studies, and 60 are cross-sectional studies in 18 provinces between 1995 and 2000.Based on these study evidences, first, we systematically conduct the comparative analysis of the benefits and weaknesses of five provider payment modes which are FFS, Capitation, flat rate, case-based, global budget, in the light of fee control,service quality,management implementation. Second, we summarize the probability and method elements of different payment modes combination, according to characteristics of each. At last, we summarize the payment modes in three typical cities of Zhenjiang, Beijing, Mudanjiang briefly.[Suggestion]According to the problem that should be paid attention to when developing provider payment mode, we made the following recommendations to improve payment mode.1. to establish social medical insurance bargaining.2. to establish the fund budget management system on the base of global budget.3. to implement DRGs step by step.4. to develop a sound evaluation system and punishment & incentive mechanism for medical institutions.