Objective: By analyzing the implementation effect of the "Service Number Point Value Method" payment method reform in Zhangjiagang City of Jiangsu Province, the paper provides decision-making reference for improving the diversified and compound payment mechanism under the DRG payment framework. Method: Based on the summary of the underlying mechanism of the "service number point value method" and the theory of internal and external circle stakeholders, a three-dimensional assessment framework of "controlling costs, ensuring quality, and improving efficiency" was constructed. Using medical insurance final settlement data from 2021 to 2024, a quantitative assessment method was adopted to evaluate the implementation effect of the "service number point value method" payment method reform. Result: The average annual growth rate of total medical expenses of Zhangjiagang City was controlled at 6.08%. The operational efficiency of medical insurance funds has been improved. The average outpatient cost per visit decreased significantly. The hospitalization rate and the 31-day readmission rate have significantly decreased, and both the quality and efficiency of medical services have improved. Conclusion: The "service number point value method" payment method reform has achieved remarkable results in Zhangjiagang City in controlling the irrational growth of medical expenses, ensuring the quality of medical services, and improving the efficiency of medical insurance fund utilization. In the future, it is necessary to further explore the relevant indicators for the formation of point value and further refine the incentive mechanism of point value to enhance the scientific nature of point value.
Key words
service number point value method /
medical insurance payment method reform /
effect evaluation
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