Study On Regulatory Mechanism Of Single Disease Payment Of The NCMS Based On Clinical Pathway

Objective:This study uses qualitative and quantitative research methods, to analysis therelevant papers about single disease payment and clinical pathway managementmode in domestic and foreign academic circles, according to our present nationalsituation, to discover the problems and the difficulties of single disease payment inthe implementation process through the field survey, learning successfulexperiences from international and partial domestic areas preliminary explore a setof suitable single disease payment supervise process for China’s national conditions.Method:This research used Quantitative Study and Qualitative as the main studymethods.The main methods include:⑴literature study: Use thenetwork,books,journals and other tools to consult the literature and datainformation,to get a comprehensive understanding of theoretical study and practicalexperience about single disease payment and clinical pathway in domestic andforeign countries.⑵field investigation: ues typical survey method, chooseDangYang City of Hubei province to be investigated, analysis the practicalexperience and effectiveness in the implementation process of single diseasepayment and clinical pathway.⑶expert interview: communincate with the directorof health department,director of NCMS management department, the relevantperson in charge of hospital,doctors and patients, to know their opinions and viewsabout single disease payment and clinical pathway.⑷Statistical analysis method:according to the nature of the survey material, use relevant statistical analysismethod, to analysis the key factors which impact the smoothly implementation ofsingle disease payment.Results:The advantages of single disease payment: ⑴Implement single diseases of payment can shorten the average days in hospitaland reduce the medical expenses of patients.⑵Implement single disease payment can improve the actual compensation leveland reduce the expenses burden of patients.The problems of single disease payment:⑴The number of single disease is too small and coverage is too narrow, which leadto the benefit crowd is limited.⑵Hospitals in order to make the cost less than in the quota pay standard, willresolve the times of patients.⑶Hospitals in order to obtain high amount of compensation, will upgrade thediagnosis.⑷Hospitals may try to avoid some high cost single disease,some patients with highcosts will be out of single disease.⑸Hospitals may reduce the quality of medical service in order to save costs.Suggestion:System designing:⑴Clear the main body and object of supervision,establish the effective supervisionmechanism⑵Make management system in order,and establish an operational mechanism thatpowers according with responsibilities.⑶Take a variety of supervision form, improve the effectiveness of supervision.The management department of New Rural Cooperative Medical Care System:⑴Step up publicity efforts to make the designated hospitals and patients know therelevant policies and procedures of single disease payment.⑵Choose appropriate single disease according to local conditions.⑶Make a set of clinical pathway to promote the standardization of medical behavior. ⑷Establish a long-effect negotiate mechanism with the designated hospitals todetermin a reasonable single disease quota standards.⑸Management department should establish a long-term supervision mechanism ofsingle disease management.Designated hospitals:⑴Pay high attention to the implementation of single disease and clinical pathway, setup a internal management department of single disease in the hospital.⑵Make single disease clinical diagnosis standards and supporting measures, set up areasonable medical cost structure.⑶Strengthen the cost management of single disease,to promote economiceffectiveness.⑷Strengthen the medical staff’s management consciousness of single diseasepersonnel.Make single disease skills training and management evaluation schemefor the medical staff.⑸Consummate the hospital information management system,strengthen themanagement of medical case and disease coding, surgical procedure codeclassification.