scholarly journals Methods to assess the efficiency of local budget performance of the compulsory medical insurance fund in the Volga Federal District

2018 ◽  
Vol 16 (6) ◽  
pp. 1014-1027
Author(s):  
N.T. Yashina ◽  
◽  
E.A. Khansuvarova ◽  
L.A. Chesnokova ◽  
E.S. Malysheva ◽  
...  
Keyword(s):  
Federal District ◽  
Medical Insurance ◽  
Insurance Fund ◽  
Local Budget

Reforming Payment Methods for Basic Medical Insurance to Accommodate Traditional Chinese Medicine (TCM) in China : A Case Study of Shaanxi Province

2020 ◽  
Author(s):  
FANG ZHOU ◽  
XIAOHAO ZHANG ◽  
ZHIGUO MA
Keyword(s):  
Medical Insurance ◽  
Diagnosis And Treatment ◽  
Shaanxi Province ◽  
Insurance Fund ◽  
Payment Methods ◽  
Treatment Services ◽  
Basic Medical Insurance ◽  
Medical Institutions ◽  
Insurance Funds ◽  
Basic Medical

Abstract Background: Traditional Chinese medicine (TCM) attaches importance to the philosophy of holism and disease prevention. Meanwhile, costs arising from TCM diagnosis and treatment services are relatively low. Such features cater to the needs of less developed countries and regions to increase the equity and accessibility of medical services and to save basic medical insurance funds. However, China’s current payment system for basic medical insurance fails to fully regard these features, thus unable to incent the demand for and supply of TCM services. Methods: Based on the analysis of the features or rather the advantages of TCM, the article, taking Shaanxi Province located in central China as an example, studies the status quo of economic development, coverage of TCM diagnosis and treatment services by basic medical insurance, implementation of payment methods for basic medical insurance in TCM medical institutions, and aims to explore the reformation of payment methods for basic medical insurance. Results: Statistics have shown that the economic power of Shaanxi Province is below average in China, as a result of which, Shaanxi Province is confronted with a general lack of basic medical insurance fund. On the other hand, the present payment methods for basic medical insurance fail to accommodate the features of TCM. Besides, only a very limited number of TCM medical institutions, service items and medicines are covered by basic medical insurance. Consequently, the advantages of TCM are not exploited to the full in a country that has always treasured TCM. Therefore, reformation in payment methods is pressing. Conclusion: In view of the economic and social development of Shaanxi Province, this article proposes to reform the payment methods for basic medical insurance by introducing a new medicinal-effect-based payment method to accommodate TCM. This payment method has the following four features. Firstly, it advocates strengthening process supervision of diagnosis and treatment activities in medical institutions, establishing a rating system for therapeutic or prophylactic effects, and implementing a reward and punishment mechanism accordingly. Secondly, special audit standards for TCM services shall be determined by the health care department of the people’s government together with the relevant TCM administrative department, more TCM institutions, service items and medicines shall be covered by basic medical insurance, and the negotiation mechanism with medical insurance institutions shall be adjusted. Thirdly, in pricing the fees and standards for TCM services, the price control administrations of the people’s government shall consult TCM experts, and dynamic price adjustments based on costs and professional technical values shall be made. Last but not least, outpatient diagnosis and treatment services shall be covered by basic medical insurance fund, a practice which will not only give full play to the advantages TCM services, but also help reduce the financial burden on patients and save medical insurance funds.

scholarly journals Healthcare Supply Chain Network Coordination Through Medical Insurance Strategies with Reference Price Effect

2019 ◽  
Vol 16 (18) ◽  
pp. 3479
Author(s):  
Gao ◽  
Wang
Keyword(s):  
Decision Making ◽  
Supply Chain ◽  
Healthcare System ◽  
Reference Price ◽  
Medical Insurance ◽  
Patient Choice ◽  
Insurance Fund ◽  
Supply Chain Network ◽  
Price Effect ◽  
The Social

China has established the universal medical insurance system and individual out of pocket costs have decreased, however, the average healthcare expenditure of the Chinese population and the expenses of the whole society have increased substantially. One major challenge which impedes the progress of attaining sustainable development of the social healthcare system in China is that the number of hospital admissions is disproportionate. Superior hospitals are overcrowded, whereas subordinate hospitals are experiencing low admissions. In this paper, we apply the game theory model to coordinate the healthcare supply chain network, which is composed of the government, medical insurance fund, superior hospitals, subordinate hospitals and patients. Especially by taking the reference price effect into account, this paper analyzes different medical insurance reimbursement strategies and their influence on patient choice and the healthcare supply chain network. The result shows that the reference price effect increases the leverage of medical insurance, guides patients’ choice, optimizes the allocation of medical resources and reduces the medical expends. In comparison to a decentralized decision- making strategy, a centralized decision- making strategy can stimulate both superior hospital and subordinate hospital’s cooperative intentions which benefits the social healthcare system.

scholarly journals Regional adaptation of the federal model of reimbursement for medical assistance based on clinical statistical groups: hospitalization of patients in need of genetically enginered biological preparations

2018 ◽  
Vol 11 (2) ◽  
pp. 44-52
Author(s):  
M. V. Sura ◽  
T. N. Ignatova ◽  
N. S. Rudneva ◽  
Yu. N. Sukhanova ◽  
N. G. Ulyanova ◽  
...  
Keyword(s):  
Day Care ◽  
Medical Insurance ◽  
Genetically Engineered ◽  
Insurance Fund ◽  
Medical Assistance ◽  
Medical Organization ◽  
Inpatient Facility ◽  
Regional Adaptation ◽  
The Russian Federation ◽  
Insurance Model

The existing model of financial support of medical assistance for clinical-statistical groups (CSGs) in 2018 provides for the reimbursement for hospital stay expenses by the compulsory medical insurance fund in patients claiming the need for genetically engineered biological products (GiBP) during their stay in a day-care or 24-hour inpatient facility. The payment is made to CSG no. 121 in a day care and to CSG no. 316 in a 24-hour inpatient facility. The heterogeneity of the expenses for therapy with GiBP necessitates further division of the Federal CSGs into subgroups located in the constituent parts of the Russian Federation. This process has been initiated in some parts of the country, and it is seen as a way of regional adaptation of the Federal Medical insurance model. The proposed subdivision of the Federal CSGs allows for setting the tariffs reflecting the real expenses incurred by a local medical organization due to the therapeutic use of GiBP. The models of such specific CSGs proposed by RF subjects (after an expert evaluation) can be taken as a basis for updating the Federal CSG model, taking into account the differences in the costs of different drug therapy regimens.

scholarly journals Application of Smart Healthcare in LTCI, Outpatient Mutual-Aid Guarantee Mechanism, and Sustainability of Medical Insurance Fund for Urban Employees

2022 ◽  
Vol 2022 ◽  
pp. 1-10
Author(s):  
Yating Ren ◽  
Zhe Yang
Keyword(s):  
Long Term Care ◽  
Population Aging ◽  
Medical Insurance ◽  
Insurance Fund ◽  
Mutual Aid ◽  
Care Needs ◽  
Term Care ◽  
Smart Healthcare ◽  
Long Run

With the aggravation of population aging and the increase of life expectancy, long-term care insurance (LTCI) system has been established to meet the medical and long-term care needs of the increasing elderly population. In China, LTCI system is currently not a stand-alone insurance, but it is attached to the national basic medical insurance fund for urban employees (MIUE). As a result, the expenditure of LTCI is a part of the expenditure of the MIUE, which has an impact on the sustainability of the MIUE. By modeling the income and expenditure of MIUE, especially including the expenditure of LTCI, this study optimized an LTCI system with a higher individual out-of-pocket payment ratio of LTCI and implementation of the outpatient mutual-aid guarantee mechanism (OMAGM), which could improve the sustainability of the MIUE. The study also reveals the following: (i) solely increasing individual out-of-pocket payment ratio of LTCI to 20%–50% can only postpone the deficit on Social Pooling Accounts (SPAs) by 1 or 2 years, and the effect is very limited. (ii) Besides a higher individual out-of-pocket payment ratio, further implementation of a partial OMAGM from 2022 will postpone the deficit on SPAs by 7–9 years, and the implementation of a complete OMAGM from 2022 will postpone the deficit by 14–18 years. Accordingly, China should implement OMAGM as soon as possible to enhance the solvency of MIUE fund, and, in the long run, an independent LTCI scheme should be established to ensure the stability and sustainability of the LTCI fund and the MIUE fund.

scholarly journals The effect of the universal two-child policy on medical insurance funds with a rapidly ageing population: evidence from China’s urban and rural residents’ medical insurance

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Xinjie Zhang ◽  
Jingru Huang ◽  
Ying Luo
Keyword(s):  
Medical Insurance ◽  
Insurance Fund ◽  
Ageing Population ◽  
Fertility Intention ◽  
Rural Residents ◽  
Basic Medical Insurance ◽  
Urban And Rural Residents ◽  
Child Policy ◽  
Insurance Funds ◽  
Basic Medical

Abstract Background With the rapid growth of the ageing population, the operating burden of China’s basic medical insurance fund is becoming increasingly heavy. To counter rapid population ageing and ameliorate a series of problems, China has adjusted its fertility policies several times. On January 1, 2016, the universal two-child policy was implemented. This study analysed the impacts of the adjustment to the fertility policy and potential improvements in fertility intention on the insured population and medical insurance fund sustainability. Methods We used an actuarial science method and took the urban and rural residents’ basic medical insurance (URRBMI) of China, which covers most urban and rural residents, as an example to build a dynamic forecast model of population growth and a dynamic actuarial model of medical insurance funds. Results Compared with the original policy, under the current fertility intention (40%) with the universal two-child policy, the ageing of the population structure of URRBMI participants will decline significantly after 2026, and individuals aged 65 and over will account for only 19.01% of the total participants in 2050. The occurrence of the current deficit and accumulated deficit of the URRBMI fund will be postponed for one year to 2022 and 2028, respectively. If fertility intentions continue to rise, the ageing degree of the population structure will decrease, and the deficit would be further delayed. Conclusions The universal two-child policy is conducive to improving the degree of overall population ageing, delaying the occurrence of a URRBMI fund deficit, and improving the sustainability of URRBMI funds. If fertility intention increases, the effects would be stronger. However, since the adjustment of the universal two-child policy has a certain time lag, it will take time to demonstrate this impact. Therefore, while actively promoting the universal two-child policy, other measures should be taken, such as improving the fertility desire among couples of childbearing age and reforming medical insurance payment methods.

scholarly journals State Financing Policy of the Modern Health Care System on the Example of Federal Compulsory Medical Insurance Fund

2019 ◽  
Vol 9 (4) ◽  
pp. 111-114
Author(s):  
A. A. Martynova ◽  
V. E. Shorokhov
Keyword(s):  
Health Care ◽  
Health Care Financing ◽  
Medical Insurance ◽  
The State ◽  
Insurance Fund ◽  
Social Significance ◽  
Financing Policy ◽  
Modern System ◽  
Financing Health Care ◽  
State Financing

Some of the many existing activities of the state are characterised by their special social significance. These areas are associated with the implementation of the fundamental social functions of the state, as a result of which they require a special order of financing. Health care financing is a type of financial activity associated with the formation of centralised funds of financial resources, as well as their distribution and redistribution through specialised insurance funds and organisations, carried out within the framework of financial relations regulated by law and based on payments when an insured event occurs by a medical organisation. This article discusses the modern system of financing health care in terms of government policy. A detailed analysis is carried out, and the special status of the Federal Compulsory Medical Insurance Fund as an actor in this field is determined, the powers and activities of which are not limited to financial components. It emphasises the need to clarify the existing scientific ideas about the regulation of the modern system of financing health care as one of the mandatory state functions.

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