A Comparative Study On The Disease Score Database In Basic Medical Insurance In Guangdong Province

Background In order to implement the No.55 Document in 2017 of the General Office of the State Council,Guangdong implemented the reform of payment by disease score in 2018.In March 2021,the government of Guangdong proposed that the Guangdong medical insurance bureau would take the lead to formulate The Disease Score Database in Basic Medical Insurance and Work Guidelines in Guangdong.Objective This research is carried out to discover the problem of the disease score database,and to provide a basis for improving the payment policy.Moreover,this study calculated the reasonable scores of diseases,and form the disease score database in basic medical insurance in Guangdong.Method To understand the progress of reforms of domestic and foreign medical insurance payment method,and to collect disease score databases and data of 18 cities in Guangdong,we carried out literature research and field research.We used the score ratio method and empirical research to compare differences in score databases of 18 cities.The problem of score databases is found.Result We found that with the exception of Guangzhou,Zhuhai and Zhaoqing,which used the direct combination method and the benchmark disease method,15 cities in Guangdong all used the coding classification method and the fixed parameter method to determine the disease and scores.77.26% of the maximum to minimum ratio are greater than 1.Z86.7 to Z99.2 are included in the disease score databases of 8 cities.The score ratios of some cities are quite different.Diseases of the cardiovascular system(I20.0 to I25.8)in the Heyuan City’s Disease Score Database are matched with the treatment method Eye Surgery.The disease score database of Guangdong contains 7891 common disease,910 primary disease,and 6125 surgery and operation codes.The score ratios of 10 diseases in a city are quite different in comparison with Guangzhou and Qingyuan.The number of cases in a hospital was unreasonable.Conclusion It is found that there are differences in disease types and score determination methods in disease score databases of 18 cities in Guangdong.The scores of some diseases are quite different.The problems in the disease scores database include unreasonable disease category settings,unreasonable combination of disease category and treatment method,and unreasonable disease scores.The scores of some diseases in a city needs to be improved.Medical violations are found in a hospital.