Study On The Mechanism And Effect Of The Cost Control Of Mixed Medical Insurance Payment Method

ObjectiveSetting forth the domestic medical insurance cost control research background,analysing the domestic and foreign medical insurance payment and the current situation of cost control research,and to construct a reasonable medical insurance cost control mechanism.Then take a evaluation of compound medical insurance payment method of Guangzhou City.Finally putting forward the reasonable suggestions and countermeasures.MethodUtilizing the method of literature analysis,query journals,dissertations,newspapers,documents of domestic and foreign health policy,rules and regulations which was related to the topic,literature review was focused on the medical insurance payment mode of cost control mechanism and the effect of different medical insurance payment;using the system theory to construct medical insurance cost control mechanism,and to explore the path of composite type of payment;using descriptive statistical analysis and paired samples t test to study the outpatients and inpatients' expenses and service quality indicators of Guangzhou City.Result1.The mechanism of the cost control of the mode of the mixed medical insurance payment is to change the remunerating form of the medical insurance agencies to the medical institutions,and change the original payment form namely Fee-for-service to a prospective payment system according to a certain standard.It mainly uses the different forms of prepaid medical insurance payment to pay the medical insurance expenses,which limits the incomecompensation of the medical institutions,acts of inducing demands then were restricted,which decreased the unreasonable medical expenses.2.After the reform of the mixed medical insurance payment system in Guangzhou,the average cost and the total cost growth rate of the public hospitals were obviously decreased.The average cost of each discharged person declined after the reform,but the changes were not very significant back and forth.The cost difference of the indicators were statistically significant(P<0.05),but there was a certain rebound after that.3.The cost containment of private hospitals was not obvious,and the fluctuation range of each cost index value was very large.The difference between the average cost of the average cost and the average cost of each discharged patient in the outpatient and the emergency department is P>0.05,which is not statistically significant.In addition,the total cost and total income of private hospitals are much less than that of public hospitals.4.Medical service quality and service efficiency have been improved compared with those before the reform,and statistical tests were statistical significant.5.The main medical risk of cost sharing was transferred from patients to medical institutions.ConclusionSince it's not the perfect time to implement the DRGs because of the technical and social barrier.We should first carry out the prepayment system based mixed medical insurance payment method,but there are still many problems in the combination of medical insurance payment methods.DRGs should be taken pilot first,and fulfill it at last.In the end,several suggestions are put forward.First,to improve the total amount control prepayment system and to continue exploring the mixed medical insurance payment mode.At present,we should continue to elaborate the management refinement of the total amount prepayment system and explore the combination of different ways of payment.Second,to implement the cost accounting system,accelerate the exploration of the clinical path,stimulate hospitals forming the awareness of cost.Thus speeding up the exploration of the clinical path and lay the foundation for the implementation of the DRGs payment mode.Third,taking medical insurance as the focus,promoting "three medical linkage" to be realized.In the course of medical reform,the healthcare,medicine and medical insurance can not be left each part,whereas three parties should be unified.Therefore helping the improvement of medical system.