The Institutional Environment And Running Performance Of Medical Insurance Payment Methods

In recent years,the current situation of social development,such as economic development and population aging,has caused rapid growth in medical demand.The financing capacity of medical insurance fund is insufficient,and the growth rate of fund income is lower than the growth rate of expenditure,which has led to the escalation of the risk of the medical insurance fund account.In order to solve the problems of rapid growth of medical demand and the risk escalation of the medical insurance fund account,the state vigorously promotes the deepening reform of medical payment methods.The government considered Disease Group Score Payment as an effective means to control the growth of medical expenses,and promoted it vigorously.Since 2018,Guangdong Province has fully implemented the Disease Group Score Payment in public medical institutions.Because of the complex operating environment and there are a lot of influencing factors,the effect and mechanism of controlling the increase of medical expenses by the Disease Group Score Payment need to be studied.Based on the analysis framework of multi principal-agent theory,this article combines the H hospital’s performance data of Disease Group Score Payment and interview record,analyzes the effect and mechanism of fee control by Disease Group Score Payment to provide a reference for the role of cost control and deepen the reform of medical insurance payment.This thesis uses literature review to collect the latest research paper of domestic and foreign scholar about medical insurance payment in fee control for case analysis and policy recommendations.This thesis also used data analysis method to obtain the performance of H hospital’s fee control,which implemented the system of Disease Group Score Payment.to assist in verifying the validity of the interview content.Third,this thesis used qualitative interview to collect questions and analyze the factors influencing the performance of Disease Group Score Payment.This thesis draws the following conclusions:firstly,Disease Group Score Payment has significant effect on fee control on H Hospital,but the effect is unstable and related to doctor’s motivation of cost control.Secondly,doctors’ hidden characteristics affect the function of fee control.Thirdly,the incentive contracts of other clients affect the fee control mechanism of Disease Group Score Payment working.Fourthly,the internal system of medical institutions interferes with the incentive mechanism for doctors,which affects Disease Group Score Payment plays a role in controlling fees.According to the conclusion,this thesis puts forward some policy suggestions.Firstly,It is suggested that the management department of medical insurance fund should optimize the detailed rules for the implementation of payment by disease score,strengthen the examination of the management methods for medical insurance payment of medical institutions,and supervise doctors’ concealed behaviors by means of information technology.At the same time,the medical insurance fund management department needs to strengthen the fund-raising ability and the purchasing ability of medical services.Secondly,the hospital carries out internal governance reform to promote the incentive compatibility between the internal system and the fee control mechanism of Disease Group Score Payment.Thirdly,the government departments issued management measures,reformed the personnel compensation system and compensation mechanism of medical institutions,improved the income level of doctors,and made doctors "only care about treatment,not worry about incomes".