The reform of medical insurance payment serves as a crucial mechanism for regulating healthcare service practices and guiding the allocation of medical resources.It plays an essential role in ensuring equitable access to high-quality medical services while enhancing the quality and efficiency of medical insurance funds.It analyzed the relationship between national specification and local adjustment,the relationship between global budget management and payment methods,the relationship between DRG/Diagnosis-Intervention Packet and multiple payments,and the relationship between process management and regular settlement in the process of promoting medical insurance payment reform in Shanghai.It also proposed policy suggestions for relationships that need to be further straightened out,to provide reference for the establishment of effective and efficient medical insurance payment mechanism.

The reform of medical insurance payment serves as a crucial mechanism for regulating healthcare service practices and guiding the allocation of medical resources.It plays an essential role in ensuring equitable access to high-quality medical services while enhancing the quality and efficiency of medical insurance funds.It analyzed the relationship between national specification and local adjustment,the relationship between global budget management and payment methods,the relationship between DRG/Diagnosis-Intervention Packet and multiple payments,and the relationship between process management and regular settlement in the process of promoting medical insurance payment reform in Shanghai.It also proposed policy suggestions for relationships that need to be further straightened out,to provide reference for the establishment of effective and efficient medical insurance payment mechanism.

Objective:To review the relevant policies and progress of Shanghai in public hospital compensation,analyze the current situation and time series of the compensation situation of public hospitals in Shanghai,and propose policy suggestions to improve the compensation mechanism for public hospitals,so as to provide references for promoting high-quality development of public hospitals.Methods:Horizontal and longitudinal descriptive statistical analysis were conducted to compare the revenue,expenditure and salary data of public hospitals in Shanghai from 2018 to 2022.Results:Shanghai has gradually optimized the revenue and expenditure structure of public hospitals under the combined effects of removing markups on medical consumables and drugs,adjusting prices of medical services,centralizing volume-based procurement,and reforming the salary system.However,the rising proportion of medical material revenue and proportion of inspection and test revenue have occupied the growth space of medical service revenue,and the medical service income cannot fully compensate for personnel expenditure.Conclusion:It is suggested to further optimize the financial compensation method,optimize the adjustment mechanism of medical service prices,strengthen the refined operation and management of public hospitals,and improve supporting policies.

Private health insurance(PHI)is an important component of China's multi-tiered medical security system,meeting people's multi-level and diversified health needs through supplementing and connecting with the basic medical insurance(BMI).It aims to draw on the practical experience of typical countries to provide implications for developing PHI that complements BMI in China.Considering the different models of medical security systems in various countries and the diverse functional positioning of PHI,France,Germany,Australia,the United Kingdom,and the United States are selected as reference objects.After examining the macro institutional systems of PHI,coverage population,benefits packages,characteristics of coordination with health care and medicines,as well as supporting regulatory measures,the experiences are summarized.Based on China's context,it proposes to improve institutional system building,enrich product supply,expand the insured population,explore the coverage list formulation,and refine supporting regulatory policies.

Objective:To review the relevant policies and progress of Shanghai in public hospital compensation,analyze the current situation and time series of the compensation situation of public hospitals in Shanghai,and propose policy suggestions to improve the compensation mechanism for public hospitals,so as to provide references for promoting high-quality development of public hospitals.Methods:Horizontal and longitudinal descriptive statistical analysis were conducted to compare the revenue,expenditure and salary data of public hospitals in Shanghai from 2018 to 2022.Results:Shanghai has gradually optimized the revenue and expenditure structure of public hospitals under the combined effects of removing markups on medical consumables and drugs,adjusting prices of medical services,centralizing volume-based procurement,and reforming the salary system.However,the rising proportion of medical material revenue and proportion of inspection and test revenue have occupied the growth space of medical service revenue,and the medical service income cannot fully compensate for personnel expenditure.Conclusion:It is suggested to further optimize the financial compensation method,optimize the adjustment mechanism of medical service prices,strengthen the refined operation and management of public hospitals,and improve supporting policies.

Private health insurance(PHI)is an important component of China's multi-tiered medical security system,meeting people's multi-level and diversified health needs through supplementing and connecting with the basic medical insurance(BMI).It aims to draw on the practical experience of typical countries to provide implications for developing PHI that complements BMI in China.Considering the different models of medical security systems in various countries and the diverse functional positioning of PHI,France,Germany,Australia,the United Kingdom,and the United States are selected as reference objects.After examining the macro institutional systems of PHI,coverage population,benefits packages,characteristics of coordination with health care and medicines,as well as supporting regulatory measures,the experiences are summarized.Based on China's context,it proposes to improve institutional system building,enrich product supply,expand the insured population,explore the coverage list formulation,and refine supporting regulatory policies.

Objective:To review the relevant policies and progress of Shanghai in public hospital compensation,analyze the current situation and time series of the compensation situation of public hospitals in Shanghai,and propose policy suggestions to improve the compensation mechanism for public hospitals,so as to provide references for promoting high-quality development of public hospitals.Methods:Horizontal and longitudinal descriptive statistical analysis were conducted to compare the revenue,expenditure and salary data of public hospitals in Shanghai from 2018 to 2022.Results:Shanghai has gradually optimized the revenue and expenditure structure of public hospitals under the combined effects of removing markups on medical consumables and drugs,adjusting prices of medical services,centralizing volume-based procurement,and reforming the salary system.However,the rising proportion of medical material revenue and proportion of inspection and test revenue have occupied the growth space of medical service revenue,and the medical service income cannot fully compensate for personnel expenditure.Conclusion:It is suggested to further optimize the financial compensation method,optimize the adjustment mechanism of medical service prices,strengthen the refined operation and management of public hospitals,and improve supporting policies.

Private health insurance(PHI)is an important component of China's multi-tiered medical security system,meeting people's multi-level and diversified health needs through supplementing and connecting with the basic medical insurance(BMI).It aims to draw on the practical experience of typical countries to provide implications for developing PHI that complements BMI in China.Considering the different models of medical security systems in various countries and the diverse functional positioning of PHI,France,Germany,Australia,the United Kingdom,and the United States are selected as reference objects.After examining the macro institutional systems of PHI,coverage population,benefits packages,characteristics of coordination with health care and medicines,as well as supporting regulatory measures,the experiences are summarized.Based on China's context,it proposes to improve institutional system building,enrich product supply,expand the insured population,explore the coverage list formulation,and refine supporting regulatory policies.

Objective:To review the relevant policies and progress of Shanghai in public hospital compensation,analyze the current situation and time series of the compensation situation of public hospitals in Shanghai,and propose policy suggestions to improve the compensation mechanism for public hospitals,so as to provide references for promoting high-quality development of public hospitals.Methods:Horizontal and longitudinal descriptive statistical analysis were conducted to compare the revenue,expenditure and salary data of public hospitals in Shanghai from 2018 to 2022.Results:Shanghai has gradually optimized the revenue and expenditure structure of public hospitals under the combined effects of removing markups on medical consumables and drugs,adjusting prices of medical services,centralizing volume-based procurement,and reforming the salary system.However,the rising proportion of medical material revenue and proportion of inspection and test revenue have occupied the growth space of medical service revenue,and the medical service income cannot fully compensate for personnel expenditure.Conclusion:It is suggested to further optimize the financial compensation method,optimize the adjustment mechanism of medical service prices,strengthen the refined operation and management of public hospitals,and improve supporting policies.

Private health insurance(PHI)is an important component of China's multi-tiered medical security system,meeting people's multi-level and diversified health needs through supplementing and connecting with the basic medical insurance(BMI).It aims to draw on the practical experience of typical countries to provide implications for developing PHI that complements BMI in China.Considering the different models of medical security systems in various countries and the diverse functional positioning of PHI,France,Germany,Australia,the United Kingdom,and the United States are selected as reference objects.After examining the macro institutional systems of PHI,coverage population,benefits packages,characteristics of coordination with health care and medicines,as well as supporting regulatory measures,the experiences are summarized.Based on China's context,it proposes to improve institutional system building,enrich product supply,expand the insured population,explore the coverage list formulation,and refine supporting regulatory policies.