Research On The Implementation And Effect Of The Total Prepayment System In A Tertiary General Hospital In Beijing

With the increasingly improvement of medical insurance system,patients enjoy medical insurance density increasing,the phenomenon of rapid growth of medical insurance fund expenditure is more and more prominent.At the beginning of the medical insurance payment set up,using the Pay per service item,lead to the doctors can guide the direction of medical expenses generated,induced prone to take advantage of information demand,the phenomenon of excessive service,incentive for the cause of the rising cost of medical treatment.Therefore,under the condition of medical insurance fund faces imbalance,reform of medical insurance payment methods.At present,the Global Budget has been fully implemented in the hospitals of Beijing in advance.To advance the implementation of the system in the hospital total present situation research,can discover the reform of medical insurance payment to the impact of hospital management activities.According to the hospital several output changes after the reform,combined with the physician's interview,identify problems and deficiencies in the payment system,eliminate system could cause the potential risks during implementation.Objective:To understand the medical insurance payment reform way influence on hospital management activities,as well as the effect of public hospital output index.From the aspect of macro policies and micro data mining changes of all kinds of influence factors,and combined with the safety factor,characteristic indexes such as extraction operation rate,average age,the analysis of the influence of the mechanism.Methods:This study used research methods including literature research,sampling survey,interview and statistical analysis research.Access to all parts of the country in recent years of total prepaid comparative study;Know about 10%of hospital physicians surveyed,path for the management of hospital total prepaid and physician behavior attitude;Compared to the total hospital changes the appraisal indexes before and after the prepayment system,explore the total prepaid and used in the evaluation indexes system affected.Results:This study found that hospitals after the implementation of total prepaid payment system,the hospital medical insurance fund growth from 17.22%to 17.22%.From hospital patients are cost,average,outpatient prescription of such confinement time cost,outpatient amount of refusal,medicine of connotation indexes such as the total system to evaluate the effect of in advance.The implementation of the New Deal on the average hospitalized patients,outpatient prescription all costs of such confinement,outpatient service to refusal of payment amount,such as index to fall,fell by 5.99%,9.20%and 5.99%respectively,the binding effect;To clinic and hospital medicine accounted for more than two indicators,there is no significant difference among the indicators flat,hospitalization time of patients costs rose 5.21%,also need further discusses the reform of management activities in which the movement mechanism.Conclusions:Through the reform of the medical insurance payment,the hospital main indexes have varying degrees of decline.Shows the Global Budget system preliminary played a constraint the excessively rapid growth of medical costs,achieved the purpose of change hospital operating behavior distortions.At the same time,to protect the medical service quality,ensure the implementation of the policy effect,also need combination of physician medical practice,further discussion to establish and perfect mechanisms,provide reference for optimization of hospital management.