Study On The Implementation Effect Of Payment By Disease Based On The Perspective Of Stakeholders

With the continuous progress of our economy and society,the medical needs of the people who visiting doctors have increased significantly,as well as the utilization of new medical projects and technologies,the medical expenses in China continue to escalate,and the stress on official medical insurance fund is still boosting.To regulate or adjust the service mode of medical establishment and the medical practice of patients,control the immoderate growth of expenses in medical treatment,the state and provinces have enacted official policy initiative to comprehensively facilitate the renovation of payment methods for health insurance.It is of great theoretical and realistic connotation to study the implementation outcome of disease-based payment policy and put forward corresponding guides to foster the effective accomplishment of medical insurance payment reform by formulating disease list of various diseases,corresponding diagnosis and treatment methods and setting prepayment standards for different diseases.This paper selects a Grade Ⅲ-A Hospital is selected as the research object to evaluate the implementation effect of disease-based payment based on stakeholder,incentive compatibility,quasi-public goods and system theory.First of all,through two times of expert interview and consultation,the evaluation indicators is formed according to the role orientation and the importance of indicators for the managers,fundraisers,suppliers and demanders.Secondly,111 cases of vocal cord polyp policy group,148 cases of control group,257 cases of senile cataract policy group and 318 cases of control group were selected for comparative analysis.The statistical calculating ways consisting of Mann-Whitney U test and Chi-square test were used to analyze the medical expenses and hospitalization stays.The structure variation degree was used to analyze the cost structure,and the question sheet for doctor-patient was designed to analyze the execution and gratification of doctor-patient in the fulfilment of the diseasebased payment policy.The results showed that the average hospitalization costs of vocal cord polyps and senile cataract decreased by 394 yuan and 92 yuan,respectively,and the self-payment costs of patients decreased by 2752 yuan and 1516 yuan,respectively.The economic burden of patients was reduced,and the average hospitalization days were shortened by 0.83 days and 0.39 days,respectively.The medical efficiency was improved.But the existing disease quota payment standard is not reasonable,it’s lack of timely adjustment mechanism;the satisfaction rate of doctors was 30.64 %,and the medical suppliers were not so willing to implement the policy.The general satisfaction of patients was 95.50%,their awareness rate of policy was only 21.20 %,and the awareness still needed to be improved.According to the research and interview consequence,correlative recommendations are provided for the in-depth implementation of the reform and improvement of the payment by disease.The first is the standard proposal of payment by disease based on the clinical pathway,the second is that this study presents recommendations from the attitude of stakeholders to stimulate the enhancement and carrying out of disease-based payment stratagem,including that managers and fundraisers should establish timely adjustment mechanism according to the standard of payment criteria,upscale policy constraints and guidance for hospitals and medical staff,they should actively set up effective connection between Single Disease Payment and Diagnosis-related Group or Diagnosis-Intervention Packet payment.Providers should inaugurate scientific,reasonable performance appraisal and incentive mechanism,continuously enhance and optimize medical service information system.Doctors should further standardize medical behavior and change their thinking mode in time.Demanders should continuously upgrade policy awareness and indicate their feedback of medical demand timely.