Health: total medical insurance payment is a continuous process of correction

ZhangHaiTong (the doctor)

Sources: health

        Under the increasing levels of medical insurance fund pays pressure, the current domestic have Shanghai, Beijing and other cities in the medical institutions, to expand the total payment system for the pilot. However, in order to avoid the total advance in hospital shuffle the critically ill patient, the medical service quality and other bad consequences, whether Beijing or Shanghai, all the necessary improvement. (on October 9, the China news weekly)

        Why the pilot implementation of the medical insurance amount payment system? The main reason is nothing but, excessive medical treatment in vogue, the medical insurance fund is already crumbling. To took the lead in the country to built town worker is basic of system of medical treatment insurance Shanghai as an example, in 2011, Shanghai medical insurance fund spending growth is more than 30%. From 2002 to 2007, Shanghai medical insurance as a whole account is in successive years close not to branch, short five years, the medical insurance fund gap accumulated unexpectedly has reached 2 billion yuan. Obviously, the implementation of the medical insurance fund can effectively guarantee the balance of the medical insurance payment system is imminent.

        So, is there a medical insurance payment system can not only let ginseng protect people generally feel satisfied, and can give full play to the medical staff work enthusiasm, but also effectively control the growth of medical expenses, and to avoid the risk of overdraft? Unfortunately, so far, there is no national, regional implementation of the medical insurance payment system can perfectly solve the problem. In an early start to implement the public free medical care of some countries and regions, such as to Britain as a representative of British commonwealth of nations, currently facing medical expenses increase too fast, medical security system burden overweight, public medical institution operation efficiency, etc. And the United States and other countries implementing multiple medical insurance system also exists serious lack of medical guarantee fairness, the resistance of the medical reform faces too difficult problem. Therefore, China is still in the pilot phase of the medical insurance payment system it is difficult to find a mature, perfect the foreign experience from according to copy with.

        From the previous pilot experience to look at, let the medical institution shall bear the risk of part of the "overrun" medical insurance amount payment system could effectively control medical cost, reduce the medical insurance fund payment pressure. However, it is also exist some disadvantages that cannot be ignored. In April this year, in the implementation of the total advance system of hebei baoding, some public hospitals to avoid medical insurance "overrun" part by oneself to take, for worker health care patients, or rejection, or request the patient at one's own expense. So, there was a lot of local worker to cooperate to Beijing medical insurance patients go to a doctor at one's own expenses of the anomalous phenomenon.

        Why will appear this kind of make the doctor-patient always troubling situation? Originally, the total medical advance is based on the number of ginseng, annual average accepts the total number of people, second all accepts cost level data, etc., and calculating the total medical treatment charge pays, the medical insurance institution with a regular, carry out total amount control, local use, overspend share payment. One of the effective implementation of the premise, the relevant data relative accurate measure. But, the domestic medical institutions exist between the fierce business competition, ordinary patients in the hospital every day "by foot to vote". For example, some hospitals through their own efforts to improve the medical service level, attracting a large number of new patients, but because the medical insurance payment amount co., LTD., but can only regret to this part worker health care patients "rejected". This undoubtedly will appear a kind of medicine, suffer from, the "very hurt" situation. Therefore, medical insurance amount payment system to enhance strong points and avoid weaknesses, improve as soon as possible.

        From the news as you can see, the relevant departments of the total medical insurance payment system made some beneficial improvement. For example, in Shanghai version of the reform scheme, if the hospital control FeiChengXiao significantly, at the beginning of the year the total budget didn't take over, balance part can continue to employ by the hospital, and ago is directly put under medical insurance department. And the Beijing is regulation, to medical insurance payment of the excess part, by the hospital should take all no longer, but by the medical insurance fund and pilot hospital according to a certain proportion to share. It is to a certain extent, mobilize the enthusiasm of the medical institutions, so as to promote the system of a certain extent, reduce the resistance.

        The author thinks that, the system improved though can yet be regarded as beneficial attempt, but they want to ensure that medical insurance amount payment system widely implement and get really effect or not enough. The new medical reform leaders want to get practical results, for the majority of patients, it is difficult to see a doctor to see a doctor to solve your problem, in addition to system details of repair and perfect, more needs to follow the following some principles. First of all, governments at all levels should earnestly increase spending on health care, to ensure that the inflation pressure increases day by day under the situation of the medical insurance fund not shrink. Second, reform, not contusion medical institutions and medical staff work enthusiasm. Relevant departments should let the medical staff believe that medical reform not to let the hospital income plunged, medical personnel income significantly reduced, but to effect a radical cure excessive medical treatment, medical care and other medical fraud mess. Moreover, the relevant departments should as soon as possible to perfect the medical insurance fund supervision and use system, fundamentally eliminate the medical insurance fund repeatedly been embezzled, corruption etc. Phenomenon occurred.