The Influence Of Remote Networked Settlement On Hierarchical Medical System And The Medical Insurance Management Countermeasures

With the process of social and economic transformation,such as aging,population movement and urbanization,residents' demand for quality medical resources and medical treatment in different places has grown rapidly.Therefore,remote network settlement for cross-regional treatment has been implemented,to improve the level and efficiency of medical treatment settlement services in different places.For a long time,Regional economic developments,along with medical and health resources are distributed unevenly in China.The hierarchical Medical System is implemented to alleviate the “double concentration” and “inverted triangle” structure of medical resources,as well as to achieve an orderly medical treatment pattern,so as to promote medical fairness.Definitely,achieving fairness and efficiency in medical services is important goals of health care reform.However,while the policy of remote network settlement for cross-regional treatment,which adapts to mobility and improves medical efficiency,brings convenience,it affects the behavior and orientation of residents' medical treatment at the same time,which may have a negative impact on the construction of the hierarchical medical system.Based on the perspective of health management and policy synergy theory,by using the health service demand theory as the theoretical framework,this study firstly uses literature research and character interview methods to learn about the present research results and the basic situation of remote network settlement and the hierarchical medical system policies at home and abroad.Secondly,with the hospitalization settlement data of A district's urban and rural residents,which is generated inside and outside Zhaoqing City,before and after the implementation of the remote network settlement policy,the study mainly uses descriptive method and variance analysis to statistically compare the trends of hospitalizations' number and expenses of A district's urban and rural residents before and after the remote network settlement policy.Results show that after the implementation of the remote network settlement policy,hospitalizations' number and expenses of A district's urban and rural residents are on the rise.In addition,the hospitalizations' number,medical expenses and personal payment expenses in the tertiary hospitals outside Zhaoqing City have increased significantly.Furthermore,PSM-DID regression analysis indicate that the network settlement policy carried out has a certain negative impact on the construction of the hierarchical medical system.Thirdly,by using literature research and character interview resources,this paper analyzes the reasons for the negative impact mainly due to the imperfection of remote network settlement policy,insufficient construction of hierarchical medical system,and poor synergy between them.Finally,the paper puts forward the following suggestions: improve the networked settlement service and management;effectively integrate medical resources;improve the service capacity and level of primary hospitals;refine the referral system and optimize payment management;jointly carry out the medical and insurance policies.