| Background: China was one of the 22 countries of heavy disease burden of TB in the world.In the TB strategy,whether the patient could finish the 6 to 8 months TB treatment cycle is one of the key factor that ensuring the therapeutic effect of TB strategy successfully.The possibility of TB in poverty colony was far more above than that in rich,while poverty was the main reason that leading to the poor treatment adherence of TB patients.Several international assistance projects offered the free health care to Chinese poor TB patients in the past.With the end of those projects,there was a crucial challenge that how to control the clinical costs in TB via the own efforts of patients,reduce the economic burden and improve the treatment adherence of TB patients in the future.As the promoting of reform in payment pattern of the on-going health system,it is possible that to solve the issue of shortfall in medical funds according to the case-based payment.Objective: To explore financing models and incentive mechanisms combine with the characteristics of TB treatment.According to implementation of case-based payment for TB in Zhenjiang,evaluate performance of the policy and provide reasonable proposals about how to play a role in case-based payment.Methodology: Zhenjiang city and Yangzhong city were selected as sample area,while the policy of single disease payment,designated hospital and TB patients were selected as study object.The study collected relevant files of policy document,admission record,medical insurance compensation information,hospital self-administered questionnaires and the interview of stakeholder.Using qualitative and quantitative methods to analyzed the data.Literature review method and SWOT analytical method were main qualitative analysis,while descriptive statistical analysis,statistical tests and Difference-in-Difference were main quantitative analysis method.Results:1.A policy of bundled payment for inpatient and outpatient separately had carried out in Zhenjiang.It stipulated that hospitalization expense of per patient was 8000 Yuan,and outpatient was 3000 with 20% co-payment percentage.The hospitalization rate should lower than 30%.2.A very small percentage of TB patients were coved by the new policy at present,only 22.26% of hospitalized patients were included in the single disease payment.3.The new policy could standard medical behavior,reduce patient appointments and hospitalization days.But the hospitalization rate was higher than 30%,which the policy required.4.The new policy could increase medical insurance reimbursement rates both inpatient and outpatient,reduce out-of-pocket costs,and lower the economic burden of TB patients.However it did not work in controlling the irrational increase of hospitalization fees,moreover,actual compensation rate could not meet the requirement of the policy.5.The new policy had no impact on motivation of medical staff,whereas income of designated hospital had declined.6.The new policy improved the treatment compliance of impoverished TB patients.Conclusion: The current policy could increase reimbursement rates and lower the economic burden of TB patients;improve the treatment compliance of impoverished TB patients.However,the payment method that paid for inpatient and outpatient separately caused distortion of the original design.Also,the constraints of services package covered by case-based payment mechanism and the lack of strategy to control medical expenditures occurred out of the package were the weaknesses of the policy.Besides,the corresponding incentive mechanism was incomplete and could not fully motivate the doctors' enthusiasm.Moreover,medical stuff was insufficient knowledge of single disease payment.It meant that Zhenjiang's case-based payment policy had not reached the expected target,as the effect was not good. |
PDF Full Text Request