Analysis On The Policy Of Payment By Disease Score In Basic Medical Insurance In Guangdong Province

Objectives: In response to the document No.55 published by the General Office of the State Council in 2017,Guangdong Province took the lead in implementing the reform of payment by disease score in basic medical insurance across the province at the end of 2017.In 2018,the agency settled with the designated medical institutions of basic medical insurance according to the payment method based on disease score.With the continuous reform of the medical and health system,this research is carried out to provide a basis for further improving the reform policy of medical insurance payment methods in Guangdong Province.Methods: Documents are searched through retrieval of databases and government-relevant websites.The data of the score database and more relevant information is obtained through field surveys.Through the comprehensive comparison and analysis of the data obtained through the above methods,to analysis the implementation of the basic medical insurance payment by disease score in Guangdong Province,the similarities and differences in policies of different cities,the current results and problems,and the data of disease scores database in different cities.Results: It was found that the reform of multi-composite payment methods based on payment by disease score of the basic medical insurance in Guangdong Province has covered 19 cities in the Guangdong province except Foshan and Shenzhen.The implementation scope and key components of the policies in the 19 cities are the same.However,there are differences in the determination of the total amount of allocable funds,the determination of disease types,the determination of disease scores,the caliber of basic data,the payment method of special diseases,the definition and allocation of cost deviation cases,and the determination of medical institution coefficients.After the standardization of the disease score database in each city,the difference in scores of most diseases is large,Medical institutions in various places generally have a high degree of recognition for payment by disease score,but there is still much room for improvement.Conclusion: To further deepen the reform of medical insurance payment policy and optimize the policy of payment by disease score,we should adopt more scientific methods to determine the disease score database,improve the coefficient calculation methods of medical institutions,improve the quality of the front page of medical records,strengthen intelligent supervision,and strengthen the policy training of medical institutions.