Research On The Reform Of Single Disease Group Payment Mechanism Of New Rural Cooperative Medical Insurance In Longhai City, Fujian Province

At present,the development of the new rural cooperative medical system(NCMS)in China is relatively insufficient.How to more effectively alleviate the medical economic burden of farmers has become an important issue in the reform of NCMS.A large number of studies at home and abroad show that choosing a reasonable payment mode of medical insurance can play an active effect in controlling irrational health care costs,elevating medical service efficiency and service quality.Based on the theory of game equilibrium and principal-agent theory,this paper takes the single payment system of NCMS as an example,and collects data in the form of on-site investigation,data collection and related personnel visits.The average length of stay and the average number of hospitalization,the average hospitalization expenses,the proportion of drugs and the examination fee before and after the implementation of the three designated hospitals in the city are compared.More than one data.The results show that the implementation of NCMS in designated hospitals in Longhai City has achieved initial results:(1)The coverage rate of inpatients has been continuously improved.In 2016,61.48%,69.51% and 49.22% of all hospitalized patients in the first,second and middle hospitals were paid for by single disease group;(2)Medicalexpenses were effectively controlled and the burden of seeing a doctor was significantly reduced.In 2016,the average hospitalization expenses of the first,second and middle hospitals in Longhai City were 4941.00 yuan,3438.00 yuan and 5065.07 yuan respectively,which decreased by21.08%,10.68% and 12.99% year on year respectively;(3)the self-paid expenses of patients were significantly reduced.The self-paid expenses of patients in the first,second and middle hospitals of Longhai City were1486.30 yuan,1042.90 yuan and 1471.56 yuan respectively,which decreased by 31.70%,33.55% and 35.39% respectively.(4)The three county-level public hospitals participating in the pilot project have changed from passive coping with reform to active cost control.The proportion of cases in route A and B is controlled at 7:3,which meets the expected target.The treatment plan is gradually standardized.The complaint rate of patients has decreased by 26.2%,and the satisfaction has been greatly improved.Although NCMS single disease group payment has achieved some results,there are still some problems in policy formulation,such as: the health insurance management institutions are at a disadvantage in negotiating the payment standard for single disease group due to the lack of health personnel;high-value consumables are not considered as an exception;and the balance of hospital fee control is not further clarified.In the implementation of the policy,there are also some problems,suchas the difficulty to improve the coverage of diseases,the need to optimize the structure of hospitalization expenses,the difficulty to supervise the charge of serial diagnosis and decomposition,and the need to improve the coverage of clinical pathways.In view of the above problems,this study also puts forward corresponding policy recommendations:(1)promoting the reform of single disease group payment system in NCMS;(2)optimizing and upgrading,strengthening the management and monitoring control of clinical pathways;(3)implementing rewards and punishments,improving the monitoring and evaluation mechanism;(4)strengthening the informatization construction of designated medical institutions in NCMS.This study demonstrates the effectiveness of the single disease group payment system in NCMS,and proves the feasibility of the single disease group payment system in the reform of NCMS payment system.It has both theoretical and practical significance for the reform of NCMS payment system and the follow-up reform of DRGs.