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| 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 |
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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.
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[1] 廖藏宜，闫俊.我国医保支付方式的改革历程及发展趋势[J].中国人力资源社会保障，2019（6）：12-15.
[2] 毕鹏飞.云南省医保支付方式改革研究分析[J].价值工程，2018，37（17）：5-7.
[3] 方洁.我国医疗服务价格与医保支付方式改革政策协同性研究[J].现代医院，2019，19（3）：313-316.
[4] 谢其鑫，程薇，倪敬年，等.某市三级甲等中医医院阿尔茨海默病门诊费用及医改前后变化分析[J].中国医药导报，2019，16（3）：44-48.
[5] 张彤.福建省建瓯市医保支付方式综合改革进展与分析[J].中国医院管理，2017，33（10）：731-733.
[6] 刘丽.2013～2017年新疆综合医院医疗费用结构变动情况分析[J].财经界，2019（10）：83-86.
[7] 冯俊，李英利，徐婷婷，等.基于结构变动度的三甲综合医院2014～2016年住院费用结构评价[J].中国医药导报，2018，15（13）：147-150.
[8] 李娇娇，杜清，相静，等.山东省县级公立医院医保支付方式改革实施现状研究[J].中国医院管理，2018，38（1）：59-61.
[9] 郭传骥，郭启勇.国内外医保支付方式和医疗服务体系的现状分析及启示[J].现代医院管理，2018，16（1）：66-72.
[10] 王建国，陈微，赵磊.“药品零差率”政策对某三甲医院医保管理的影响[J].才智，2019（2）：216-218.
[11] 邵立新.新形势下医保政策在医院管理中心的作用[J].临床医药文献杂志，2018，5（25）：187-188.
[12] 王晓曼，周琼，朱海珊，等.医保支付方式改革背景下公立医院存在的问题及对策[J].医学与社会，2018，31（3）：50-52.
[13] 孙潇璨.新医改环境下如何更好发挥医保总额控制的作用[J].经营与管理，2019（4）：7-9.
[14] 常峰，纪美艳，路云.德国的G—DRG医保支付制度及对我国的启示[J].中国卫生经济，2016，35（6）：92-96.
[15] 纪京平，张乐辉，郭默宁，等.医保综合支付方式改革引导医疗行为改变的实证分析[J].中国卫生经济，2017， 36（5）：56-58.
[16] 任海丽.按疾病诊断相关分组医保支付改革的重要性[J].中国药物与临床，2019，19（7）：1170-1171.
[17] 王爽.公立医院运用医保政策加强经济运行管理的分析[J].中外企业家，2019（28）：52-53.
[18] 梁若浩.新医改下新疆公立医院运营现状分析及对策建议[J].绿色财会，2019（2）：45-51.
[19] 瞿婷婷，解乃琪，易沛.医疗保险支付方式改革与医药费用控制[J].南开经济研究，2019（5）：145-163.
[20] 卢春柳.健康中国背景下医保支付改革趋势[J].中国卫生产业，2019，16（19）：128-129. |
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