The Cost Effectiveness Analysis On The Implementation Of Fee-for-Service And Diagnosis Related Groups On The Basis Of Medical Insurance System

Background:Medical insurance expenditure payment affects macroscopically the development of national medical and health undertakings,at the same time it affects microcosmically the quantity and quality of medical service which is closely related to the patients. Therefore, developing reasonable and effective medical expenses payment is the key links of the national health care reform, and the success of the reform is also the key to control the unreasonable increase of medical expenses.In recent years, China began to study the combination of DRGs and fee-for-service.The Ministry of health issued the first batch of DRGs quality control index in 2009. Based on the fee-for-service, the government began to implement the DRGs in many hospitals.In the implementation process, the DRGs do play a role in regulating the clinical diagnosis and treatment, but there is still a contradiction between the payment standards and actual demands and the problem of supporting the policy which is not in place.Objective:Based on the expense of medical insurance payment system, cost effectiveness analysis of the DRGs and fee-for-service is done in the project. And the advantages and disadvantages of the two kinds of payment methods is compared to provide advice of perfecting China's medical expenses payment system.Theories and methods:First of all, the present medical insurance payment system of our country and the development of the payment system is analyzed to summary the problems existing in the implementation of the payment system. Based on the theory of public interests and risk theory, the role and function of each department in the course of the reform of payment system is analyzed, and groups strive for their own interests in the reform of medical insurance expenses payment system. The method of economic analysis is used in the study and AMI is selected as the object of study to account the cost of the fee-for-service patients and DRGs patients.And then the effect of two kinds of payment system is analyzed in order to compare cost effectiveness between the DRGs and fee-for-service.Result:Although there are various problems and obstacles in the implementation process of the DRGs, the implementation of the clinical pathway has a good effect.The implementation of clinical pathway management for specific diseases can effectively control the medical expenses and standardize the medical staffs medical treatment behavior., The cost effectiveness of DRGs patients is obviously better than the fee-for-service patients in the study.Therefore, the government should continue to implement the DRGs and continue to optimize the quality control index of diseases, and strictly carry out clinical pathway management in order to further improve the quality of medical services.