A Comparative Study On The Management Mode Of Urban And Rural Basic Medical Insurance In S City And X City In The Process Of The Joint Reformation For Public Health Service,medical Insurance,and Medical Production-Circulation

Deepening the reform of the medical and health system is one of the important tasks of building a well-off society in an all-round way.Since a new round of medical system reform has proposed,positive progress has been made in the deepening of medical system reform with remarkable results,including the basically established national medical insurance system and the greatly improved guarantee level to initially form the scientific management system and operation mechanism.As the medical system reform enters into the deep end and critical stage,the problem of interest adjustment becomes more complicated,and the contradiction of institutional mechanisms is gradually highlighted.“Coordinate and Promote the Joint Reformation for Public Health Service,Medical Insurance,and Medical Production-Circulation” was clearly proposed in the government work report of the State Council in 2016 to indicate that medical system reform will enter the stage of system integration and comprehensive promotion.Various regions have carried out active exploration and practice in such aspects as promoting the joint reformation for public health service,medical insurance,and medical productioncirculation,giving full play to the overall function of medical insurance,promoting the reasonable and effective connection between medical insurance system,establishing incentive and restraint mechanism for medical service behaviors,avoiding repeated construction,reducing the cost of public management and improving the operation efficiency,etc.With the innovation of medical insurance management system as a breakthrough,the pilot areas of comprehensive medical system reform such as S City of F Province and X City of J Province have integrated the various medical insurance systems distributed in multiple departments and managed by one department in a unified manner.Meanwhile,the medical and health system reform,the medical insurance system reform,the drug circulation system reform are promoted,and the integrity,systematicness and synergy of the joint reformation for public health service,medical insurance,and medical production-circulation are improved significantly.Based on the analysis of the management mode of urban and rural basic medical insurance in S City and X City in the process of the joint reformation for public health service,medical insurance,and medical production-circulation,this paper makes comparative study on the difference of medical insurance management mode,reform effect and problems in two cities,and puts forward countermeasures and suggestions on how to deepen the reform of medical insurance management system,improve the efficiency of the management and utilization of medical insurance fund,and give full play to the basic role of medical insurance in deepening medical system reform and promoting the joint reformation for public health service,medical insurance,and medical production-circulation: the medical insurance management institutions undertake the functions of medical insurance handling and medical insurance fund management,and have the external restrictive role on medical services.They can effectively restrain and encourage medical service practices,and play a fundamental role in coordinating the interests of all parties in the tripartite relationship of hospitals,patients and medical insurance companies.On the basis of integrating various medical insurance policy systems,it is necessary to improve the overall planning level,establish the co-ordination mode of unified collection and allocation of funds at the municipal level,improve the utilization efficiency of funds,give full play to the overall functions of medical insurance,and promote the effective connection between various medical insurance systems;to rationalize the management responsibilities,unify the medical insurance,medicine price as well as tendering,procurement and management departments,and establish the medical insurance management institutions which belong to the government and have the functions of policy formulation,fund raising management,medical service price management,drug procurement supervision and control,and medical behavior supervision;unify the handling mode,establish the operating management system for the vertical management at the prefecture level,establish a unified network informationsystem for urban and rural basic medical insurance throughout the city by adopting Internet + and big data technology,realize the information sharing among basic medical insurance,major disease insurance and medical assistance of urban and rural residents,improve the level of precision and intelligence of medical insurance operating services,and also strengthen the intelligent supervision and control means of medical insurance so as to effectively control the rapid increase of medical expenses;reform the payment method,implement the performance evaluation of medical insurance payment to improve the utilization efficiency of fund,by establishing payment negotiation mechanism between medical insurance and medical institutions,adopt the payment policy of“over-expenditure sharing,surplus retention and performance payment”,give play to the leverage effect of medical insurance payment on medical behaviors,promote the doctors to actively improve the medical quality and help the insured to obtain good prognosis effect of diseases;establish the negotiation and purchase mechanism,and give full play to the basic role of medical insurance in medical system reform.To reduce the “artificially high” price of medicines and consumables by means of bulk procurement,so as to create a favorable condition for the improvement of the payment range and standards of medical insurance fund,the adjustment of the prices of medical services,and the reform of public hospital salary system.