Research On The Improvement Of Medical Insurance Payment Methods For Dying Elderly With Major Diseases

With the aging of the population,the increased prevalence of the elderly population and the changes in the disease spectrum,the elderly population with major diseases is increasing.The elderly who suffer from major diseases generally receive excessive and ineffective medical services and have excessive medical expenses in the terminal stage,but the condition cannot be reversed,resulting in waste of medical resources and unreasonable use of the medical insurance fund.Therefore,it is necessary to explore ways to solve the problem of ineffective over-medical treatment for the elderly with major diseases and dying from the perspective of medical insurance payment methods.This study takes Shanghai as an example.It mainly uses three methods:literature review,interview and case study.Based on the analysis of existing research,the analysis of relevant theories,and the summary of the current payment methods for medical insurance for the dying elderly with major diseases,13 cases of dying elderly with major diseases were studied.This paper conducts research on the case of dying elderly with major diseases through in-depth interviews,and analyzes the problems existing in the current payment methods and the adverse effects caused by them.The study found that there are still many problems in the current payment system for medical insurance for dying elderly with major diseases in Shanghai.For example,the payment standard under the total prepayment system is not reasonable enough;the medical insurance payment method is not refined enough;the control of medical service quality is neglected;the payment system lacks effective constraints on the unreasonable demand of the demand side;lack of supervision on self-financing expenses outside the medical insurance catalogue,etc.Under the influence of current medical insurance payment methods,both the supply and demand sides of medical services breed moral hazard behavior in the game.The supplier has actions such as reducing the effective supply of medical services,reducing the quality of medical services,and over-provisioning ineffective medical services.The demand side has behaviors that breed unreasonable medical needs,over-consume medical resources,and induce medical service supply.At the same time,the current medical insurance payment method has caused many adverse consequences for both the supply and demand sides of medical services.The adverse consequences for the supplier mainly include the lack of enthusiasm for the reform of the medical staff to cope with the payment method and the lack of trust of the patients and their families.The adverse consequences for the demand side include:the need for soothing care cannot be met;the necessary psychological needs cannot be met;the elderly and their families are tossed;passively receiving over-medical and high-cost self-financed medical services.Finally,based on the international advanced experience,this research proposes the following improvement strategies:at the system design level,practice classified payment and refined management,verify a reasonable total budget,formulate reasonable payment standards,and strengthen supervision and management of relevant stakeholders;at the level of relevant supporting measures,improve the supply capacity of primary medical institutions,establish a reasonable credit system for medical institutions,realize information disclosure and information sharing in the medical market,and improve the grading diagnosis and treatment and family doctor system.