Case analysis and enlightenment of capitation payment system reform
Shaohua Kuang, Qi Jing, Zhaofang Zhu, Bin Cui, Yingchun Chen, Mengxuan Zou, Jing Gao, Jingjing Chang
Published 2019-05-02
Cite as Chin J Hosp Admin, 2019, 35(5): 353-357. DOI: 10.3760/cma.j.issn.1000-6672.2019.05.001
Abstract
ObjectiveTo analyze the main practices of capitation payment system reform in the case areas and put forward enlightenments and suggestions in this regard.
MethodsThe implementation practices of the case areas were summarized, and descriptive statistical analysis was carried out on the implementation effects.
ResultsBy analyzing the effectiveness of the case areas′ reform, it was found that the case areas are curbing the excessive growth of medical expenses (for example, outpatient fees per visit of Dingyuan county-level hospitals decreased from 245.11 yuan in 2015 to 218.40 yuan in 2017), increasing the actual compensation ratio of residents (for example, the actual compensation ratio of Funan increased from 59.80% in 2015 to 63.28% in 2017), forming a medical treatment pattern within the county (for example, out-of-county compensation ratio in Dingyuan decreased from 37.38% in 2015 to 31.13% in 2017), achieving double-way referrals (for example, the number of referrals to superior hospitals of Jimo increased from 98 in 2015 to 328 in 2017), improving the subsidence of quality services, and controlling the risks of medical insurance funds.
ConclusionsAt present, the reform of the case areas has been implemented steadily and achieved results. It is recommended to further improve such aspects as reform coordination, insurance standard setting, incentive mechanism establishment, and leadership to ensure the reform progress.
Key words:
Capitation payment; Payment system reform; Case analysis; Enlightenment; Cost control
Contributor Information
Shaohua Kuang
China Rehabilitation Research Center for Deaf Children, Beijing 100191, China
Qi Jing
School of Public Health and Management, Weifang Medical University, Weifang 261053, China
Zhaofang Zhu
China National Health Development Research Center, Beijing 100044, China
Bin Cui
School of Public Health, Peking University, Beijing 100191, China
Yingchun Chen
School of Medicine and Health Management, Tongji Medical College of Huazhong University of Science &
Technology, Wuhan 430030, China
Mengxuan Zou
Faculty of Health Sciences, University of Bristol, Bristol BS8 1TH, UK
Jing Gao
School of Public Health, Peking University, Beijing 100191, China
Jingjing Chang
School of Medicine and Health Management, Tongji Medical College of Huazhong University of Science &
Technology, Wuhan 430030, China
