Reform Course and Driving Factors of American Medicare Payment Mode and Implication for China
- VernacularTitle:美国Medicare支付方式改革历程和驱动因素及对我国的启示
- Author:
Zirong ZHU
1
;
Lingli ZHANG
1
;
Jianzhou YAN
1
;
Rong SHAO
1
Author Information
1. National Drug Policy and Medical Industry Economy Research Center，China Pharmaceutical U niversity，Nanjing 211198，China
- Publication Type:Journal Article
- Keywords:
American Medicare;
Medicare payment mode reform;
Payment by disease diagnosis related groups;
Driving factors
- From:
China Pharmacy
2020;31(5):545-549
- CountryChina
- Language:Chinese
-
Abstract:
OBJECTIVE：To provide reference for deepening the reform of medical insurance payment mode in China. METHODS：By analyzing the specific reform process and driving factors of American Medicare ，and considering the background of current payment reform in China ，then some suggestions were put forward to promote the reform of medical insurance payment mode in China. RESULTS & CONCLUSIONS ：The payment mode of Medicare in the United States had undergone three stages ， which were post-payment system ，pre-payment system and value-based payment system. The payment modes included payment by service items ，payment by disease diagnosis related groups （DRGs）and payment by service value. The change was the result of the comprehensive effect of the three systems of technology ，politics and social culture in the United States. The demand for reasonable treatment and control fees drove the change from post-payment system to pre-payment system ，while the crisis of service quality ， the rise of service cost and the contradiction between doctors and patients drove the change to value-based payment. Payment mode reform had a positive impact on Medicare in the United States ，reducing medical expenditure and improving the quality of service. It is suggested that China should draw lessons from the experience of the United States in reforming the prepayment system nationwide on the basis of the current DRGs pilot projects. Meanwhile ，in order to avoid the medical quality crisis in the later period of the United States ，it is necessary to introduce the concept of value-based payment ，establish incentive and restraint mechanisms and strengthen the construction of the regulatory supporting system for the whole process.
