The influence and countermeasure of the reform of medical insurance payment method in a third-class hospital in Xinjiang
CAILIKE·Baitiguli1 JIANG Xiaoming2 HU Shujiang3 ZHANG Fan4
1.College of Public Health, Xinjiang Medical University, Xinjiang Uygur Autonomous Region, Urumqi 830001, China;
2.The Second Hospital of Xinjiang Medical University, Xinjiang Uygur Autonomous Region, Urumqi 830054, China;
3.Office of Medical Insurance Management, the Second Hospital of Xinjiang Medical University, Xinjiang Uygur Autonomous Region, Urumqi 830054, China; 4.Department of Medical Administration, the Second Hospital of Xinjiang Medical University, Xinjiang Uygur Autonomous Region, Urumqi 830054, China
Abstract：Objective To analyze the impact of the reform of medical insurance payment methods on a third-class hospital in Urumqi, and to propose countermeasures based on the results. Methods The medical insurance related data of a third-class hospital in Urumqi from 2014 to 2018 were collected. While combined the interview method, the results were analyzed. Results Xinjiang implements a compound payment method that was dominated by the total amount of control and the average amount of control. However, the implementation of payment by disease was slow. The number of hospital visits in the hospital from 2014 to 2018 were increased year by year. Compared the medical insurance patients' annual hospitalization and outpatient expenses, the differences were highly statistically significant (P ＜ 0.01). The average cost of medical service visits of urban employees of the hospital was higher than that of urban/urban and rural residents. In addition, from 2014 to 2018, Xinjiang′s basic medical insurance overall payment ratio was increased slightly, but there was still a large gap between different types of medical insurance. Conclusion In recent years, the hospital′s number of doctors has increased year by year, and the second-time average medical cost control work has been completed well. However, payment by project is still the main charging method, and the implementation of payment by disease is slow. The lack of specific measures and effective monitoring methods in the current reform of the medical insurance payment method in Xinjiang may result in the hospital's enthusiasm in the implementation process. The hospital should start from its own, and actively explore practical implementation methods for payment by disease, such as adjusting clinical pathways, reducing medical costs, doing a good job in fee control, improving the degree of medical insurance information, and truly implementing the reform policy.
柏提古丽·才力克1 姜小明2 胡曙疆3 张帆4. 医保支付方式改革对新疆某三甲医院的影响及对策[J]. 中国医药导报, 2020, 17(14): 43-46,56.
CAILIKE·Baitiguli1 JIANG Xiaoming2 HU Shujiang3 ZHANG Fan4. The influence and countermeasure of the reform of medical insurance payment method in a third-class hospital in Xinjiang. 中国医药导报, 2020, 17(14): 43-46,56.
2020, Vol. 17 
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