Objective： An understanding of the levels and trends of medical cost is made for breast cancer patients with different medical insurance coverages in China（mainland）, in an attempt to offer a clue to further contro...Objective： An understanding of the levels and trends of medical cost is made for breast cancer patients with different medical insurance coverages in China（mainland）, in an attempt to offer a clue to further control the costs.Methods： The inpatient payments of 9,716,180 breast cancer patients spent in medical institutions of different types and grades during 2011–2015 were collected from the inpatient medical record home page（IMRHP） dataset.The data were then processed with SAS（Version 9.3; SAS Institute, Cary, NC, USA）. Indicators like means,increase（decrease） percentages were used to descriptively analyze the average hospitalization expense of each time（AHEET） and its trends of breast cancer patients with different medical insurance coverages treated in medical institutions of different types and grades.Results：In 2011–2015,the AHEET borne by breast cancer patients in China had been constantly increasing.Specifically,the self-pay inpatients had the largest increase,inpatients covered by Urban Employee Basic Medical Insurance（UEBMI）and Urban Resident Basic Medical Insurance（URBMI）were the next,and those covered by New Rural Cooperative Medical System（NRCMS）had the least increase.Breast cancer inpatient treated in public hospitals had quite greater increase and higher expenditure level than those in private hospitals.The AHEET borne by the inpatients in Grade 3 hospitals had greater increase and higher cost than those in Grade 2 hospitals.Conclusions：The inpatient payments of breast cancer patients will be wisely controlled by reducing the number of self-pay inpatients,taking advantage of restriction mechanism of the medical insurances,and promoting healthy competition between private hospitals and public hospitals.The economic burden imposed on the society by breast cancer can be relieved through further control of inpatient payments of UEBMI-and URBMI-covered breast cancer patients and of Grade 3 hospitals.展开更多
Objective To study the successful experience of implementing diagnosis related group(DRG)payment system in the United States and provide a reference for China’s reform of health insurance payment.Since the United Sta...Objective To study the successful experience of implementing diagnosis related group(DRG)payment system in the United States and provide a reference for China’s reform of health insurance payment.Since the United States is the first country to develop and apply the DRG in the world,its research and practice of DRG are always at the forefront.Methods Literature research method was used to investigate DRG payment system,the specific steps of the payment,the setting method of relevant indicators,and the quality supervision measures.Results and Conclusion There are mainly three aspects from the experience of DRG payment system in the United States.Firstly,the government’s responsibility for health insurance is clarified.Secondly,the relevant indexes are set reasonably.Thirdly,the DRG weight and base rate are adjusted dynamically to ensure the fairness of DRG payment.Therefore,China should pay attention to the following three aspects:clarifying the main responsibility of the government in the reform of health insurance payment,establishing the quality control system of the first page of medical records,and improving the supervision mechanism for medical quality.展开更多
The supply of basic pension is seriously lacking, the personal accounts is operated with no money. This is a problem belonging to conversion cost in essence. This paper points out that the government should undertake ...The supply of basic pension is seriously lacking, the personal accounts is operated with no money. This is a problem belonging to conversion cost in essence. This paper points out that the government should undertake the responsibility to solve the problem by using the increment method and stock method to repay the latent liability; then the government can enrich the personal accounts in response to the aging population crisis and the concussion brought by the endowment insurance system＇s conversion.展开更多
The settlement of the medical insurance fund is the key point of the implementation of the big data diagnosis&intervention packet(DIP)under the regional global budget.This study proposed the framework with key met...The settlement of the medical insurance fund is the key point of the implementation of the big data diagnosis&intervention packet(DIP)under the regional global budget.This study proposed the framework with key methods for the settlement of DIP on medical insurance funds through on-site survey and policy literature analysis.The results show that the settlement framework,featuring“Fund pre-allocation”,“Monthly pre-settlement”and“Annual settlement”,integrates ideas of both the pre-payment system and post-payment system.“Monthly pre-settlement”being the key part of the settlement process,plays an important role in breaking down the year-end pressure of medical insurance management organizations and healthcare institutions,and guiding providers’reasonable behaviors.“Annual settlement”acts as the core link of settlement,which determines the annual medical insurance fund payment amount of healthcare institutions,which needs to rely on and integrate key elements such as regional global budget,DIP grouping database and correction,and healthcare institution supervision and assessment.The settlement process,measurement methods,and key parameters must be clarified by introducing settlement and related supporting policies,which provide technical support and institutional guarantees for the implementation and effectiveness of the DIP reform.展开更多
基金supported by National Natural Science Foundation of China (No. 71403189)
文摘Objective： An understanding of the levels and trends of medical cost is made for breast cancer patients with different medical insurance coverages in China（mainland）, in an attempt to offer a clue to further control the costs.Methods： The inpatient payments of 9,716,180 breast cancer patients spent in medical institutions of different types and grades during 2011–2015 were collected from the inpatient medical record home page（IMRHP） dataset.The data were then processed with SAS（Version 9.3; SAS Institute, Cary, NC, USA）. Indicators like means,increase（decrease） percentages were used to descriptively analyze the average hospitalization expense of each time（AHEET） and its trends of breast cancer patients with different medical insurance coverages treated in medical institutions of different types and grades.Results：In 2011–2015,the AHEET borne by breast cancer patients in China had been constantly increasing.Specifically,the self-pay inpatients had the largest increase,inpatients covered by Urban Employee Basic Medical Insurance（UEBMI）and Urban Resident Basic Medical Insurance（URBMI）were the next,and those covered by New Rural Cooperative Medical System（NRCMS）had the least increase.Breast cancer inpatient treated in public hospitals had quite greater increase and higher expenditure level than those in private hospitals.The AHEET borne by the inpatients in Grade 3 hospitals had greater increase and higher cost than those in Grade 2 hospitals.Conclusions：The inpatient payments of breast cancer patients will be wisely controlled by reducing the number of self-pay inpatients,taking advantage of restriction mechanism of the medical insurances,and promoting healthy competition between private hospitals and public hospitals.The economic burden imposed on the society by breast cancer can be relieved through further control of inpatient payments of UEBMI-and URBMI-covered breast cancer patients and of Grade 3 hospitals.
文摘Objective To study the successful experience of implementing diagnosis related group(DRG)payment system in the United States and provide a reference for China’s reform of health insurance payment.Since the United States is the first country to develop and apply the DRG in the world,its research and practice of DRG are always at the forefront.Methods Literature research method was used to investigate DRG payment system,the specific steps of the payment,the setting method of relevant indicators,and the quality supervision measures.Results and Conclusion There are mainly three aspects from the experience of DRG payment system in the United States.Firstly,the government’s responsibility for health insurance is clarified.Secondly,the relevant indexes are set reasonably.Thirdly,the DRG weight and base rate are adjusted dynamically to ensure the fairness of DRG payment.Therefore,China should pay attention to the following three aspects:clarifying the main responsibility of the government in the reform of health insurance payment,establishing the quality control system of the first page of medical records,and improving the supervision mechanism for medical quality.
文摘The supply of basic pension is seriously lacking, the personal accounts is operated with no money. This is a problem belonging to conversion cost in essence. This paper points out that the government should undertake the responsibility to solve the problem by using the increment method and stock method to repay the latent liability; then the government can enrich the personal accounts in response to the aging population crisis and the concussion brought by the endowment insurance system＇s conversion.
基金supported by the National Natural Science Foundation of China General Program[grant number 72174149]the Ministry of Education Humanities and Social Sciences Research Planning Fund Project[grant number 21YJAZH102]the Ministry of Education Humanities and Social Sciences Key Research Base Self-initiated Projects[grant number 1203-413100050].
文摘The settlement of the medical insurance fund is the key point of the implementation of the big data diagnosis&intervention packet(DIP)under the regional global budget.This study proposed the framework with key methods for the settlement of DIP on medical insurance funds through on-site survey and policy literature analysis.The results show that the settlement framework,featuring“Fund pre-allocation”,“Monthly pre-settlement”and“Annual settlement”,integrates ideas of both the pre-payment system and post-payment system.“Monthly pre-settlement”being the key part of the settlement process,plays an important role in breaking down the year-end pressure of medical insurance management organizations and healthcare institutions,and guiding providers’reasonable behaviors.“Annual settlement”acts as the core link of settlement,which determines the annual medical insurance fund payment amount of healthcare institutions,which needs to rely on and integrate key elements such as regional global budget,DIP grouping database and correction,and healthcare institution supervision and assessment.The settlement process,measurement methods,and key parameters must be clarified by introducing settlement and related supporting policies,which provide technical support and institutional guarantees for the implementation and effectiveness of the DIP reform.
