The Applied Research Of Value-based Insurance Design In China In The Context Of New Health Reform

The world’s governments are facing the situation of increas ing growthhealth care costs and demand for health services, whether the U.S.market-driven health insurance market, or the Western European countries, theimplementation of government-led welfare medical insurance market, have notsolve this problem. Usually the measures taken by governments around theworld, increasing the collection efforts of the health insurance and reduce healthservice utilization as it seems a natural choice, however, this will only lead tothe reduction of necessary medical services, and cannot ensure the health of themasses.Value-Based insurance design (VBID) as a health insurance programemerging in the United States, it can improve the inherent lack of medicalinsurance co-payment, it does not focus on the cost and even the qua lity ofmedical care, but out of concern the value of medical services. Its central goal is not to control costs, but the insured population with better population health. Italso take a "clinically sensitive, and financially responsible" path to alignincentives, and reduce the negative clinical effect that accompanied by theimproved co-payment. Therefore, for a similar predicament faced by our countryat current health care reform, VBID successful pilot e xperience in the UnitedStates can bring a new idea to China’s health care reform.In recent years, although the new round of health care reform has achievedgreat results in our country, but in the work of deepen the health care reform, thereform of public hospitals becomes one of key task. Under the guidance of theexisting health insurance policy, a number of public hospitals also began toadjust the internal regulations, and guide the behavior of Health care marketparties involved to fit the health insurance policy requirements. In this thesis, bystudying the intervention project of the behavior of patients with diabetes, andthe policy effects of one three-level hospital’s controlling the medical expenses,and combining the implementation of the VBID project experiences and lessonsin the U.S. health care market, to explore the reference of the VBID on ourcurrent deepening medical reform. The study after both supply and demandintervention found that VBID concept has a greater value for our country’shealth care reform, able to balance the relationship between cost control andimprove population health, reducing the use of the high cost of hospital services,improving the use of outpatient services, and it can control the growth trend ofthe cost of hospitalization without causing the adverse health effects. Theseuseful pilot studies have provided a constructive view for medical insurancepolicy maker, to guide the medical market parties involved behavior.