A Case Study On The Reform Of Medical Insurance Payment Mode In Meishan City

In recent years,with the rapid growth of medical and health expenses in China,the pressure of medical insurance fund payment is increasing day by day.In order to solve these problems,the state has issued several opinions on the reform of the payment mode of basic medical insurance,and put forward the comprehensive implementation of multiple and compound medical insurance payment mode based on the payment of diseases.Pilot reforms of medical insurance payment methods have been launched across the country.Meishan,as one of the first provincial pilot cities of DRG payment mode reform in Sichuan Province,officially launched the exploration and practice of medical insurance payment mode reform in 2018.In accordance with the principle of "gradual and smooth transition",Meishan city has gradually promoted the reform of medical insurance payment mode in three stages of "pilot,promotion and improvement".We have standardized the total payment control of basic medical insurance,clarified the principle of "keeping surplus and reasonable compensation for overspending",and carried out payment by DRG and payment by bed per day according to different types of diseases.In DRG payment,we have implemented technical specifications for grouping and payment,quality evaluation of the first page data of medical records,performance evaluation,intelligent audit and supervision,etc.In the payment by bed day,measures such as index control of total bed days in hospital have been implemented.Finally,a multi-compound medical insurance payment system was formed on the premise of total amount control and based on DRG payment,achieving win-win results of "patients,hospitals and medical insurance" by reducing patients’ treatment burden,improving hospital service quality and efficiency and enhancing medical insurance governance capacity.Based on evidence-based research and research on incentive mechanism and implementation effect of domestic and foreign literature on medical insurance payment methods,this paper chooses incentive compatibility theory and principal-agent theory as research theories.Then,the internal data related to the reform of medical insurance payment mode for inpatients in Meishan city are collected,and the Case of Meishan is summarized,and the analysis framework of how the client（medical insurance department）can use the incentive and restraint mechanism to prevent the moral hazard of the agent（designated medical institution）is constructed.It is found that the reform of medical insurance payment mode will lead to the change of agents’ moral hazard.By introducing incentive compatibility,clients can effectively prevent agents’ moral hazard by establishing incentive and restraint mechanism in participation constraint,positive incentive,negative incentive and behavior monitoring.After the case study of meishan medical insurance payment mode reform,this paper extracts the experience and practice of promoting the reform of medical insurance payment mode,and draws three conclusions: The first is to build a prepayment system based on multiple complex medical insurance payment system.Second,we should establish and perfect incentive and restraint mechanism to ensure that hospitals can effectively prevent and control adverse selection while actively participating in the reform.The third is to strengthen the reform of the basic security work,including strengthening information technology and talent team construction,to strengthen the disease classification,payment standards and the management of the first page of medical records and other basic norms.It provides some reference for other areas in China to implement the reform of medical insurance payment mode.