Research On The Effect Of Medical Insurance Payment Reform On County Medical Community Under The Background Of Hierarchical Diagnosis And Treatment

Objective By analyzing the typical area county medical body to carry out the medical insurance payment reform of practice and has achieved,analysis of medical insurance payment mechanism of action of the reform of the county medical body and the impact on various stakeholders,to explore the county medical body to carry out the medical insurance payment total reform of hierarchical diagnosis and treatment,the influence of as to provide theoretical basis for further promoting the construction of the grading system.Methods In the part of current situation analysis,systematic evaluation method was adopted to search Chinese and English websites such as CNKI,Wanfang,VIP and Pub Med with keywords of "medical community" and "medical insurance payment" to sort out the reform measures and achievements of medical community medical insurance payment methods in some counties in China.In the part of empirical analysis,37 county medical institutions were selected nationwide based on the standard of whether to implement prepayment of total medical insurance.Taking resource sinking,radiation-driven,two-way referral,service capacity,service efficiency,economic burden and income and expenditure structure as evaluation dimensions,paired t test and rank sum test were used for analysis.Results 1.Current situation research results: in typical areas,the county medical community adopts the compound payment mode,which is mainly based on total prepayment,supplemented by payment according to disease type and capitation.At the same time,it allows the medical community to distribute the balance of medical insurance fund independently,and the overspending part is responsible or reasonably shared by itself.In view of the demander,the reform is carried out by setting up the standard of starting payment line of different levels of medical institutions and differential reimbursement.Through the reform,the medical community medical insurance fund in typical areas has a surplus,and the surplus in some areas is more than 20 million yuan;the growth rate of medical expenses shows a downward trend,and the growth rate of medical expenses in some areas drops to less than 5%,and the phenomenon of excessive growth of medical expenses is under control;the number of actual compensators of the insured group increases,and the number of compensators in some areas increases by more than 40000 in three years;the number of compensators in some areas increases by more than 40000 in three years The satisfaction of patients in different regions increased,especially in Youxi County,from 56.4% to 67.5%.2.Mechanism and influence research results: the county medical community carried out the reform of medical insurance payment,and formed an incentive and restraint mechanism among the stakeholders.It can balance the interests of all parties in the county medical community,realize incentive compatibility,and promote medical institutions to control fees independently,so as to reduce service costs and ensure service quality and efficiency at the same time.However,taking Yunxian medical community of Yunnan Province as an example,this study found that the current health manpower of primary medical institutions in medical community is relatively insufficient,which is difficult to meet the medical service needs of the demander.Therefore,it is necessary to expand the construction of primary health talent team and strengthen policy publicity.3.Empirical analysis results: the reform of medical insurance payment mode promoted the sinking of experts and technical resources in the leading hospitals of medical community(P < 0.05),and effectively played a leading role in the radiation of primary medical institutions(P < 0.05);the two-way referral mechanism between the member units and the leading hospitals gradually formed(P < 0.05);the service capacity of medical institutions in the county has been improved(P < 0.05),but the service efficiency has been improved The efficiency still needs to be improved(P >0.05);the economic burden of patients has been alleviated to a certain extent(P <0.05);the proportion of medical insurance fund in the income of medical institutions has increased,and the income and expenditure structure has changed(P < 0.05).Conclusion "Global budget,balance retained" is the main measure of medical insurance payment reform in the county medical community at present.After the reform of medical insurance payment mode,an incentive and constraint mechanism has been formed among the key stakeholders of the county medical community,but there are still some problems,such as the weak guiding role of differential payment for the demander and the shortage of grassroots talents.The reform of medical insurance payment mode has a significant effect on the county level diagnosis and treatment system,,but the effect on the service efficiency of medical institutions is not obvious.Therefore,in the subsequent reform,more attention should be paid to the role of medical insurance payment and service efficiency of medical institutions,so as to provide assistance for the better implementation of the hierarchical diagnosis and treatment system.