Stakeholder Analysis Of Immediate Settlement On Trans-provincial Medical Treatment For Rural Residents Participating In The Basic Medical Insurance In The Beijing-Tianjin-Hebei Region

ObjectivesThe study aims to understand the status quo of immediate settlement on trans-provincial medical treatment for rural residents participating in the basic medical insurance(insured rural residents)in the Beijing-Tianj in-Hebei region,and find out the existing issues;then,analyze the major stakeholders involved in the process of immediate settlement,and explore the influences between the major stakeholders and the immediate settlement;thus,provide relevant policy suggestions for this work.Contents1.First part is to review the concepts,connotations,theories and research status of immediate settlement on ecdemic medical treatment and stakeholder.2.Second part is to analyze the policy measures,information technology,business process and settlement methods of immediate settlement on trans-provincial medical treatment for insured rural residents in the Beijing-Tianjin-Hebei region,and summarize the main problems.3.Using the stakeholder analysis method,third part is to analyze the degree of relevance,the execution intention and the policy influence of the major stakeholders of the immediate settlement.4.Fourth part is to explore the influences between the major stakeholders and the immediate settlement,thus provide the corresponding strategic suggestions.Methods1.Literature researchBy searching literature and documents relating to research topic through the literature databases and government portals,the relevant theories,domestic and foreign practices were systematically reviewed.2.Field investigationQuestionnaire surveys and semi-structured interviews were used to understand the basic situation of immediate settlement on trans-provincial medical treatment for insured rural residents in the Beijing-Tianj in-Hebei region.3.Stakeholder analysisStakeholder analysis included identifying the major stakeholders involved in the immediate settlement process and understanding the characteristics of the major stakeholders using analysis indicators by means of questionnaire surveys and in-depth interviews.4.Expert consultationExperts were consulted while designing the questionnaires,identifying the stakeholders,identifying the major stakeholders and determining the analysis indicators.5.Descriptive statistical analysisThe qualitative and quantitative data collected from the questionnaires,in-depth interviews and expert consultations were analyzed by common statistical methods.Results1.Basic situationIn the respect of policy measures,Beijing,Tianjin and Hebei have differences in pooling&compensation policy and reimbursement policy,and they all stressed referral system.In the respect of information construction,there are differences in management information system construction,medical institution networking,settlement platform construction and supportive information system construction among the Beijing-Tianjin-Hebei region.In the respect of business process,a process including medical management,registering&filing,advance account management,medical expense settlement and medical expenses clearing has been designed.In the respect of pilot application,although the Beijing-Tianjin-Hebei region hasn't had the attempt directed at the insured rural residents,the "province to province" settlement model has been applied to other residents.In the respect of main problems,among the Beijing-Tianj in-Hebei region,the pooling levels of basic medical insurance are low and various,the information construction of immediate settlement is variant,and the system planning is weak.2.Stakeholder analysisThe stakeholders of immediate settlement on trans-provincial medical treatment for insured rural residents in the Beijing-Tianjin-Hebei region are human resources and social security departments,departments of finance,health and family planning commissions,medical insurance agencies,information management agencies,medical institutions where people participate in the basic medical insurance,medical institutions where people get trans-provincial medical treatments,institutions undertaking settlement platforms,insurance companies and insured rural residents.Among them,the major stakeholders are human resources and social security departments,health and family planning commissions,medical insurance agencies,medical institutions where people participate in the basic medical insurance,medical institutions where people get trans-provincial medical treatments and insured rural residents.The extent of stakeholders' roles,interests,positions,alliances,resources,power and leadership affect the degree of relevance,execution intention and policy influence of stakeholders,respectively.Conclusions1.The human resources&social security department,the medical insurance agency and the medical institution where people get trans-provincial medical treatment each have high degree of relevance and great policy influence,so the execution intention of these three institutions need to be strengthened.For the human resources and social security department,the enthusiasm of the staff should be mobilized,and the overall planning and coordination capacity should be improved.For the medical insurance agency,the enthusiasm of the staff should be mobilized,and the risks of medical insurance funds should be avoided.For the medical institution where people get trans-provincial medical treatment,ensuring that the medical insurance reimbursement is received within the prescribed time limit is necessary.Although the policy influence of the insured rural residents is weak,the needs of different kinds of the insured rural residents which are the biggest beneficiaries should be considered.2.Major stakeholders influence the systematic planning,pooling level and information construction of immediate settlement on trans-provincial medical treatment for insured rural residents in the Beijing-Tianjin-Hebei region,and the immediate settlement causes problems about the risk of regulation and incentive&constraint mechanism for major stakeholders.RecommendationsTo strengthen the immediate settlement on trans-provincial medical treatment for insured rural residents in the Beijing-Tianjin-Hebei region,relevant authorities should adjust the interest relationships of major stakeholders;gradually improve the pooling level of the basic medical insurance in the Beijing-Tianjin-Hebei region;accelerate the construction of information technology,so as to strengthen the foundation of immediate settlement on trans-provincial medical treatment;implement risk control and effective supervision;establish the assessment mechanism and the incentive&restraint mechanism;develop the concept of holistic view and form the composition of political forces through the systematic planning.