Incentive And Risk Analysis Of Medical Insurance Global Budget System

ObjectiveThe purpose of this study is to explore the impact and performance of the implementation of global budget on hospital medical behavior and medical behavior,as well as the changes in medical quality risk and cost risk caused by the global budget system.By balancing the incentive and risk factors in the global budget system,we put forward suggestions for improving the global budget system.MethodIn this paper,the literature research method is used to consult the academic journals and dissertations,which are related to the risk of the global budget system,and to select the evaluation indicators that affect the incentive and risk of the global budget system.The positive incentive function,negative incentive effect,medical quality risk and cost risk of the global budget system are analyzed by theoretical analysis.By using case analysis and statistical analysis,the actual situation of the global budget system of a comprehensive grade three hospital in Guangzhou was studied,and the related indexes were analyzed and discussed.Result1.The medical quality evaluation index of a hospital in Guangzhou showed that the average length of stay in 2015-2016 years decreased.The rate of use of sickbeds increased.The number of bed turnover increased.The coincidence rate of pathology and clinical diagnosis was increased.The successful rate of rescuing critically ill patients increased by about 4%.The fatality rate of the hospital has declined and maintained at a relatively low level for 2 years.2.The statistics and analysis of the hospitalization expenses of the basic medical insurance for urban workers in a hospital in Guangzhou showed that the overall medical insurance rate of urban workers in the hospital was on the rise,and the total cost of medical insurance rose by about 90 million yuan in 5 years,and the cost of self fee increased greatly.The average cost and the proportion of drugs changed little,but the proportion of laboratory fees increased.3.The statistical analysis of the global budget system incentive and quality risk index in 2015 and 2016 shows that the incentive index and the quality risk index have changed.Comparing the beds of a hospital and a three grade hospital in Guangzhou,the use of beds in the hospital is higher than that in the three grade hospitals in Guangzhou.4.The total cost,the average cost and the self fee ratio of 2015 and 2016 were statistically analyzed by the statistical analysis.The results showed that the difference between the total cost and the self-expenditure ratio in 2015 and 2016 was statistically significant(P < 0.05),while the difference of the average cost was not of the significance of the total cost(P > 0.05).Comparing the medical cost table of a hospital and a three grade hospital in Guangzhou,the average cost of the hospital is about 34% less than that of the three grade hospitals in Guangzhou.The average cost of the hospital is about 34%.Conclusion1.The global budget system has the function of controlling fees to improve the management level of internal control fees.After the implementation of the global budget system,hospitals are more strict in the monitoring of doctors' diagnosis and treatment.2.The implementation of global budget system promotes the improvement of medical service efficiency.Through empirical research and analysis,the hospital's medical service efficiency index has improved significantly before and after the implementation of the global budget system.3.The effect of the global budget system on the patient's medical quality risk is less.Through the empirical analysis,the medical quality of the hospital is generally in the rising level,which indicates that the risk of medical quality of the patients is reduced.4.The implementation of the global budget system increased the risk of the patient's medical expense,and analyzed the medical insurance costs of the urban workers and workers in the two years before and after the global budget system implemented.The global budget system had an impact on the medical expenses of the patients,and to a certain extent increased the risk of medical expenses for the patients.Hospitals and doctors have the possibility to against global budget.Therefore,it is suggested to take the following measures: First,it is suggested to build a scientific medical insurance cost payment method,absorb the advantages of various payment methods,make up the shortcomings and get a more reasonable cost control effect.Second,it is to build a scientific and reasonable medical institution management compensation mechanism,to ensure the positive incentive effect of the global budget system;Third,a complete system of medical insurance and control fees should be perfected to reduce the quality and cost risks brought by the global budget system;Forth,it is to establish the standard of scientific medical expenses;and fifth is to establish a scientific doctor performance evaluation system and a salary distribution system.