Medical security fund is the core of medical security system. The traditional system of medical security fund management has enabled various governmental departments to play positive roles, and has controlled the growth of expenditure. Since the Reform and opening-up, along with the reform of medical security system, a scientific and reasonable fund-raising mechanism has been established, the management of medical security fund has been societalized, and the supervision and regulation mechanisms of registered healthcare agencies have been initially established, all of which further promote the reform and development of healthcare system. But the existing management system is not perfect, and a medical security fund system which adapts to China's national conditions and the needs of the development of healthcare system must be further explored.

Objective:To investigate the payment methods of 5 kinds of chronic diseases in public hospitals of Heze.Methods:8 383 cases of hypertension,diabetes,coronary heart disease,chronic bronchitis and hepatitis B were enrolled from the Municipal Hospital,the Second People's Hospital,the Third People's Hospital,the City Hospital of Traditional Chinese Medicine and the Infectious Disease Hospital in Heze from January 1,2012 to December 31,2015.The information of medical records and the cost of hospitalization were collected and analyzed.Results:The total hospitalization expense,examination fees and other costs of medicare patients were significantly higher than those of the non-medicare patients(P＜0.05),while the drug expenses were significantly lower than that those of non-medicare patients(P＜0.05).As to the medicare patients,hospitalized expense of male patients was significantly higher than that of female(P＜0.05),hospitalized expense and insurance expense of patients over 45 years old were significantly higher than those of patients under 45 years old(P＜0.05),hospitalized expense and insurance expense of retired patients were significantly higher than those of patients on-the-job(P＜0.05),total expense of urban patients were significantly higher than those of rural patients(P＜0.05).Conclusion:Payment of patients with chronic diseases was in relation with hospitalization expenses,which was also related to the social economic characteristics,but it was worth paying attention to avoiding excessive medical treatment and waste of resources,which needed to take comprehensive measures in combination with social situation.

Objective:To explore the impact of childcare burden on satisfaction level of the elderly medical demand in family,in order to provide the basis for policy making to realize healthy aging.Methods:Based on CFPS(China family panel studies) data,using OLS and quantile regression to conduct quantitatively study on the impact of children's dependency ratio on medical expenses for the elderly.Results:The estimates of children's dependency ratio's coefficients were significantly negative,while their absolute values presented a tendency of increasing with the increase of quantile.It showed that the crowding-out effect of childcare burden on medical expenses for the elderly was in existence.The higher medical expensed,the stronger the crowding-out effected.Conclusion:Childcare burden impacted the satisfaction level of the elderly medical demand,especially for the elderly often sick or suffering from a serious illness,whose medical demand would be even greater.

With the silver wave struck,China has becone the only country entered the elderly population country with lower income.How to solve the pension dilemma faced by the large elderly population was an unprecedented severe problem that China must face in 21st Century.Through the field research,it led and eucowraged private funds enter the pension service market basde on the construction of mdeical suppotr integration legalsand regnlations.How to provide the diversirfication of the main body and expand the path,how to establish medical support integration pension service information network platform,how to implement the nursing statls' training mechanism for medical suppor integration and how to scientificallg integrate the service resonrces for medical support integration were analyzed.The existing problems of medical support integration service mode in Shenyang was analyzed to provide development suggestions and strategies so as to provide strategic thought for implementing medical support integration in Shenyang.

As the largest hospital group,performance payment distribution system directly affects the work enthusiasm of nurses.It analyzed and summarized the current 8 deficiencies and defects existing in the wage distribution.It proposed 5 measures and methods to focus on the performance payment so as to improve the enthusiasm of nurses work and promote the medical service quality and the comprehensive performance of hospitals.

Based on the patient,bundled payment was known as episode-based payment,which pay the overall treatment cost on a or multiple medical service providers.In the current,there were 3 main bundled payment model in the United States,including confirm service,Prometheus and service improvement payment.The series of research showed that,bundled payment could decrease the cost of medical service based on keeping even improving medical service quality.Based on diagnosis related groups (DRGs),bundled payment increased total prepayment control and introduced the calculation method on cost prepayment ratio and potential avoidable allowance and reward for complication.The cost control based on the evidence and the incentive mechanism based on the encourage were all worth for references.

Based on the comparison of financial information disclosure among public hospitals,enterprises,government and non-profit organizations,it proposed to establish a system framework on public hospitals financial information disclosure framework combined with the guidance of urban public hospital comprehensive reform pilot,including information published main body,object,scope,contents,method,time,form,quality assurance and violations.

Financial information disclosure was the weak link in public hospitals information disclosure,information provided to outside by hospitals was priority to basic medical information,opaque finance will hinder the reform and benign development of public hospitals.It analyzed the impact on operation management,transparency,and compensation of public hospitals financial information disclosure.It pointed out that published financial information can promote public hospitals' internal control,strenghthen financial work well informed and participation by all staffs,reinforce the external supervision of public hospitals with hardening budget and cost constraints.

Objective:To further analyze the reasons for operating loss of the sample hospital so as to resolve the developing predicament of children's hospitals.Methods:The financial data of the sample hospital from 2013 to 2015 were selected to compare the workload,incone structure,average cost and project cost before and after the medical reform so as to analyze the reason for the operation loss of the sample hospital.Results:According to the analysis results,the operating loss of sample hospital could be attributed to the following reasons:the healthcare pricing was underpaid with the high service costs,the quantity of outpatient service declined with the change of income structure,the financial compensation by legal was not fully funded.Conclusion:From the perspective of external policy,government medical service pricing should reflect the particularity of pediatrics.Government should increase the public subsidy to children's hospital.From the perspective of hospitals,children's hospital should optimize the service process,develop the characteristics of specialized pediatrics and control the medical cost to improve health care quality while improving market competitiveness.

Objective:To analyze the efficiency of 77 public hospitals' medical services and influencing factors in Tianjin.Methods:Using DEA method to measure the hospitals' medical service efficiency,establishing Tobit regression model to analyze the influencing factors of public hospitals medical service efficiency.Results:The overall efficiency of Tianjin public hospitals was low,most hospitals were not reasonable in the size,the significant influencing factors of Tianjin public hospitals' medical service efficiency including the per capita physician outpatient,the proportion of senior technical staffs,hospital gearing ratio,drug-income ratio and average fee per patient.Conclusion:Increasing the per capita physician outpatient and the proportion of senior technical staff could significantly enhance the overall technical efficiency,while decreasing the gearing ratio and the average fee of per patient were also beneficial to improve hospital efficiency.