Research On The Optimization Of Compound Payment Method Under Total Amount Control

Since the implementation of medical insurance total amount control management in China,the situation where medical expenses grow remarkably has been greatly restrained.For medical institutions,the implementation of amount control can help to save the cost and strengthen the control-charge awareness of the whole industry through restraining costs.In this context,the reform of health insurance payment method has become the top priority of the whole health care reform.And the comprehensive implementation of total amount control management is an important measure to promote the reform of health insurance payment method.However,in the process of implementation the total amount control payment method will also be faced with many problems and drawbacks.As a result of a single payment method cannot satisfied the demand of the total amount control,we need to study a new payment method.According to the actual situation of each region and medical institutions,we carry out the optimization of composite payment method.Based on the introduction of the reasons for total amount control of medical insurance payment,the relationship between the control total and the payment method,the paper focuses on the payment method under the total amount control such as “person-time quota payment method”,“point number method”and“disease group(DRGs)payment method”.This paper analyzes the present situation and problems of the “point method” under the context of total amount control,and the trial implementation and problems faced by DRGs in China.Then,taking the ET hospital's implementation of the total amount compound payment method as an example,the necessity of optimizing the compound payment method under the control total of the medical insurance payment was elicited.Starting from optimizing the control total indicators and rationally using “counting method” under the control total for promoting DRGs,a control total estimation model was established and optimization suggestions were put forward for achieving the goal of improving the quality of medical services through payment system optimization,which will promote the further reform and development of basic medical insurance payment system in China,and lay the foundation for the standardization of internal control systems for public institutions,especially hospitals.