Case Study On The Total Payment Control Of Pengzhou Medical Insurance Fund

The "Decision of the Central Committee of the Communist Party of China on Comprehensively Deepening the Reform of Some Major Issues" adopted by the Third Plenary Session of the 18 th CPC Central Committee requires reform of the basic medical insurance payment method.The total payment of medical insurance funds as one of the payment methods for medical insurance has been mentioned many times.China has established a basic medical insurance system,and the insured population has achieved large-scale coverage,and the number of participants has increased year by year.The focus of medical insurance work has gradually shifted from the expansion of the insurance coverage to the improvement of the level of protection and the reform of medical insurance payment methods.In 2012,Human Resources and Social Security,People's Republic of China and other ministries issued a "pay-total control regarding the development of the basic medical insurance",the document proposes to gradually promote the implementation of the health insurance fund to pay the total control of the country,to ensure that the health insurance fund.Pengzhou implemented the total payment of medical insurance funds from June 2013,and gained some experience after several years of operation.This article takes Pengzhou as an example,referencing the practical history of limiting the medical insurance expenditure both at home and abroad and research achievements acquired from Internet,libraries and other informational channel,studying and researching theories and examples of this limitation policy profoundly and deeply,Using public product theory,general management theory,and relevant knowledge points of reinforcement theory,using theoretical research methods,literature research methods and empirical analysis methods.This dissertation analyses the detailed process of motivating the limitation policy in Pengzhou with major contents of management functions,working from Planning Function and perspective of Public-Deciding to enact the project of allocation;referring to Control Function to go through the procedure of seasoned examination;analysing risk of this limitation policy based on Incentive Theory.In conclusion,the passage infers three essential points of success in Pengzhou.First,focus on the scientific nature of the total indicator allocation plan.In the process of formulating the plan,we respect the historical reality,take into account the future development trend,and emphasize social participation.The second,Pay attention to the assessment and evaluation during the operation of the index,design a combination of rigid and flexible indicators,a combination of qualitative and quantitative indicators,and a comprehensive measurement index system combining horizontal and vertical indicators.The third,Focus on incentive guidance in the process of policy implementation.The combination of positive and negative incentives,combined with material incentives and spiritual incentives,guides institutions to manage themselves and share fund risks.The whole case study process follows the basic principles of ?research preparation – collecting data – data collation – analytical research – research results? of social research methods,making the final research results objective and reliable,to a certain extent for other regions.Provide reference for relevant work.