The Study Of Influence And Countermeasures Of Global Budget For Beijing Municipal Public Hospitals

Reform of Medicare payment system is the key to promote reasonable medical expenses.Since the establishment of fundamental medical insurance system,constantly increasing medical costs are still a major problem challenging our country.Medicare payment means are very important to regulate the flow of medical resources;it will also significantly influence medical institutions and insured persons.Therefore,how to choose a scientific and rational health insurance payment method is the key to health care management in reality.Prepayment,as a method of payment,has been implemented both internationally and domestically.Through reviewing literature,comparison study,in-depth interviews,and data analysis,we analyzed four pilot hospitals in Beijing implementing Medicare prepaid,analyzed the current status of prepayment implementation in these four hospitals,including changes in total health insurance costs,the expenditure of Medicare fund as well as changes in the number of Medicare patients and costs.At the same time,to understand the effect of the implementation of the system in pilot hospitals.Through studying the problems and impacts after implementation of the system,weproposed targeted suggestions for theeffective implementation of the Global Budget systemin Beijing top three public hospitals and policy-making references for the government departments.According to the data analyzed by above methods,We found that,with the implementation of the total prepayment system,the amount of Medicare patients and medical service costs increased gradually.However,the average Medicare expense per patient and medication cost percentage have shown a downward trend.The main reasons which caused the hospital total prepaid overruns are the increase of the new technology and treatment,the issues of supplies procurement and use,more critical patients,etc.The refusal patients,excessive service and decomposition of medical treatment did not occur.After the implementation of the total prepayment system,achievements include: The rapid rise in health insurance fund costs has been effectively controlled;and the average cost of hospitalization and drug proportion has decreased.The management of Department of Medical insurance and hospitals has been improved.Deficiencies: the management of medical insurance institutionsare not refined;the medical procedures is not well-supervised;hospital management level need to be further improved;the situation of decomposition medical treatment and refusal patients still exist.Through referring to the current status of Medicare payment reform,summarizing existing problems,learning from international experience,we propose to improve the implementation of total prepayment by integrating a variety of payment methods,reasonable total expenditure estimation,improving the assessment mechanism;learning from successful experience from other countries,strengthening informatics technology;seizing the current overall situation in health care reform,"Tri-Meds-Linkage",advancing the prospective payment of total amount money systemand introducing negotiating mechanism between hospitals and health care institutions.