Research On The Payment Method Of Outpatient Coordinates Of Urban Residents’ Basic Medical Insurance In Gansu Province

Medical insurance is an important part of social insurance. With the development of economy and the increasing income level, people pay more and more attention to their health. Medical insurance plays a more and more important role in our life. Outpatient expenditure closely related to our life has also been included in the scope of basic health care. In 2009, it was put forward in the NO.66 document sent by Country people club department that according to paying capacity of the urban resident basic medical insurance fund, outpatient expenditure will be gradually included in the basic medical insurance fund based on the key protect residents’ inpatient expenses and outpatient medical expenses of a serious illness. Since then, the outpatient coordinate slowly developed across the whole country.The outpatient coordinate developed rapidly,and also aroused the concern of scholars. Based on the reviews of the foreign and domestic researches, the author found their researches focused on the policy and theory of outpatient coordinate,mixed use of medical insurance payment, medical expense control and so on. But they rarely researched on the measurement of payment mechanism. This article calculated the starting line; the limit line and payment proportion, and wished to provide some references for the medical insurance management department.Since 2009,the outpatient coordinates of urban residents’ basic medical insurance was already develop in Gansu province. This paper analyzed the conditions for outpatient coordinates in Gansu province from urbanization,aging of population,income level, medical level,the enthusiasm,and elaborated on the present situation of the outpatient coordinates of urban residents’ basic medical insurance from coverage,financing,the system design,payment method,settlement procedure and medical service management.There have been some resistances in the process of development of the outpatient coordinates of urban residents’ basic medical insurance in Gansu province. The author found there have been some problems in the outpatient coordinates which were local policy standards were not unified; policies were not understood in place,and medical insurance fund risk was bigger; payment method was not reasonable,and security effect was unsatisfactory; payment mechanism was not reasonable, and medical expenses burden was not practical ease; problems existed in management and supervision and so on. Based on the research of the above questions,the article put forward some reasonable suggestions in formulating unified outpatient coordinate policies; increasing the publicity, setting up the mechanism of negotiation,and playing a role of a bulk; exploring the implementation of composite payment method; calculating the reasonable payment proportion based on past data; improving the information management,and strengthening the supervision of the designated medical institution. Through the above research,the author hoped to further the outpatient coordinates of Gansu province.Finally, the author put forward their own ideas of the method of urban residents’ out-patient payment in Gansu province based on the domestic and foreign advanced experience.