The Research on the Systematic Impact Pathway of Outpatient Chronic and Special Disease Payment Methods in Basic Medical Insurance for Urban and Rural Residents

doi:10.19546/j.issn.1674-3830.2023.5.015

China Health Insurance ›› 2023, Vol. 0 ›› Issue (5) : 97-103. DOI: 10.19546/j.issn.1674-3830.2023.5.015

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Abstract

Objective: The paper explores the systematic impact pathways of payment method effect of outpatient special chronic disease system (OSCDS) in Urban and Rural Resident Basic Medical Insurance (URRBMI), and investigates the key influencing factors, which can provide the theoretical basis for optimizing the payment system in outpatient of URRBMI. Method: We set an expert group of medical insurance and analyze the scoring results by DEMATEL to evaluate the importance of each influencing factor. With the ISM model, we establish and discover the systematic impact pathways and key influencing factors of payment method effect. Results: The DEMATLE findings reveal that the level of designed medical institutions, actual service costs, the number and admission criteria have a higher centrality in the payment method of OSCDS, which have a significant impact on other factors and are not affected by other factors. The ISM model shows that the systematic impact pathway of the payment method effect of OSCDS is divided into five levels. The payment method effect of OSCDS is mainly determined by the original factors, namely the level of designated medical institutions and the actual service cost of outpatient chronic and special diseases, the original factors will directly affect the effective underlying factors, i.e.the number of disease types and admission criteria, and effective underlying factors will indirectly influence other indirect influencing factors, thus influencing the efflect of payment method reform. Conclusion: The optimization and improvement of the OSCDS payment methods design should not only focus on the difference in service capacity and actual service costs of designated medical institutions, but also scientifically and rationally adjust the number of disease types, admission criteria and supporting payment policies.

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outpatient chronic diseases system / effect of payment / systematic impact pathway

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The Research on the Systematic Impact Pathway of Outpatient Chronic and Special Disease Payment Methods in Basic Medical Insurance for Urban and Rural Residents[J]. China Health Insurance. 2023, 0(5): 97-103 https://doi.org/10.19546/j.issn.1674-3830.2023.5.015

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