Problem Analysis And Solution Exploration On The Payment Standard Of The Basic Medical Insurance

In recent years,medical and health expenditure continues to grow rapidly,and the problem of "limited access to medical treatment and expensive medical treatment" is prominent.At the same time,the social health insurance fund is also facing the risk of "bottom-up".In the new health care reform,it is clearly pointed out that the important leverage role of medical insurance payment in regulating medical service behavior and controlling the excessive growth of medical and health expenditure should be brought into full play.The standard of medical insurance payment is an important part of medical insurance payment.If the standard of medical insurance payment is too high,it will cause waste of medical resources,which is not conducive to guiding the price of drugs to be reasonable and reducing the pressure of medical insurance fund.If the standard of medical insurance payment is too low,it may cause hospitals to pass the buck to each other,doctors to reduce the quality of medical services,and may increase the pressure of insured patients to pay for themselves.Therefore,scientific and reasonable formulation of medical insurance payment standards is very important.This paper takes C city of Sichuan Province as an example,using the basic research method of presenting problems,analyzing reasons and solving problems,to make a deep analysis of the problems and causes of the payment standard of basic medical insurance in C city of Sichuan Province,and to put forward feasible countermeasures and suggestions.The first chapter introduces the background and significance of studying the payment standard of basic medical insurance in C city of Sichuan province.At the same time,it briefly summarizes the research on the payment standard of medical insurance in domestic and foreign academic circles,and clarifies the content and method of the research.The second chapter briefly introduces the relevant concepts of this paper,and expounds the theoretical basis of this paper,namely the theory of public goods and public choice,game theory,supply and demand theory of medical insurance market.Chapter three illustrates the current situation of payment standard of basic medical insurance in C city of Sichuan province according to payment mode classification.Chapter IV combining the internal data and typical cases from the author's daily work as well as the interviews with the leaders and staff of the medicalinsurance bureaus of the districts and counties of C city,finds out the problems existing in the current payment standard of basic medical insurance in C city of Sichuan province,namely,the "same price but different quality" of medical insurance purchasing medical services,the poor effect of positively guiding the service behavior of medical institutions,and the long-term fixed payment standard of medical insurance.The reasons for each problem are analyzed.And it is found that although there are objective factors,the main reason is still due to the imperfect formation mechanism of basic medical insurance payment standard.Therefore,in the fifth chapter,according to the experience and the mature model in the world,the solutions are put forward from the angle of innovation system and construction mechanism,that is,to gradually build the payment level of medical insurance,to improve the negotiation mechanism of medical insurance payment standard and to establish the dynamic adjustment mechanism of medical insurance payment standard.The last chapter summarizes the main conclusions and puts forward further research directions.