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Study on Two-way Referral Under Basic Medical Insurance System

Author: WangZiWei
Tutor: ZhangLiang
School: Huazhong University of Science and Technology
Course: Social Medicine and Health Management
Keywords: Health insurance Two-way referral Status quo
CLC: R197.1
Type: Master's thesis
Year: 2010
Downloads: 306
Quote: 1
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Abstract

Implications for research: to establish the starting point of the two-way referral system for common diseases and frequently-occurring disease in the community health service institutions can be resolved, serious illness and other incurable diseases in large and medium-sized hospitals or specialist hospital for diagnosis and treatment, the reasonable diversion of the patient, the real to achieve a reasonable pattern of \Basic medical insurance for sustainable development is also facing the challenges posed by an aging population and chronic diseases, affect the security of the health insurance fund, to promote basic medical insurance and two-way referral organic combination of great significance. Optimize the allocation of health resources, to promote the rational triage of patients; reduce medical costs, save Medicare funds, is conducive to the reform of the medical insurance system; promote medical institutions distinct functions, strengthen medical collaboration; promote the development of community health services, reflecting the characteristics of community health services, The primary hospital fundamental road out of the woods. Data sources and methods: 1, data sources use PubMed, EBSCO, ProQuest, ISI Web of Knowledge foreign language search tools, Chinese Journal of CNKI database, [. Knowledge Network, the relevant departments and research institutes website search Collect relevant literature. And through the website of the Ministry of Health, Human Resources and Social Security Web site and Health Statistics Yearbook collection of relevant statistical data. In December 2009, investigators went to Guangdong Province, Zhuhai City, Guangdong Province, as a field research site is selected, the selection of patients and doctors conducted a questionnaire survey and in-depth interviews, the relevant personnel. 2 Methods 2.1 literature review and the status quo of the intelligence analysis of the two-way referral various data types of literature, affecting two-way referral systematic literature search and data query, on this basis, with the same purpose independent study to compare the results and comprehensive analysis to summarize the main points in the various types of literature. 2.2 Field survey selected extract 2 General Hospital, Zhuhai City, Guangdong Province, as a field research station, and was extracted from the General Hospital to establish two-way referral two community health service centers, a total of 2 General Hospital and four community health service institutions. Each agency randomly conducted a questionnaire survey, residents were collected 157 valid questionnaires were returned, community and hospital doctors 67 valid questionnaires. 2.3 Key informant semi-structured interviews conducted semi-structured interviews by medical insurance management, community health services management, the management of the General Hospital, doctors and other medical institutions, to understand China's two-way referral and basic medical insurance combined with existing problems, basic medical insurance for two-way referral, and for solving the current problems suggestions and opinions. 2.4 statistical analysis method of comprehensive utilization of SPSS and Excel statistical software for data analysis. Application of descriptive statistical analysis methods combined with the status quo of community health service institutions, two-way referral and basic medical insurance, two-way referral factors for analysis. 2.5 stakeholder analysis related to the two-way referral stakeholders seven parties of the general hospitals, community health services, general hospital physicians, community physicians, patients, health care sector and health administration (government), analysis of the various stakeholders the interests of the resources available, position, focus on the analysis of the role of health insurance in the two-way referral. The study found that the combination of the basic medical insurance and community health services is of great significance. But at the same time the combination of basic medical insurance and two-way referral there are still some problems. Health authorities and medical insurance management department lack of effective communication; lack of policy support, the lack of an effective basis: two-way referral lack of uniform standards, procedures, basic medical insurance system is not reasonable adjustments to the interests of the relationship between medical institutions, basic medical insurance patients with system boot is not enough, is not binding on the insured person, must be part of the community health projects not included in the basic medical insurance reimbursement; General Hospital lack of driving force and the effective control of the two-way referral, community health service institutions lack of capacity; medical treatment philosophy offset. Policy recommendations to improve the basic medical insurance system reform Medicare Payment: expansion of community health services included in the basic medical insurance payment, the reform of the health insurance payment, reasonable adjustments to the economic benefits of the medical institutions, opened the community health service institutions and the proportion of hospital reimbursement, reduce the pay line; formulate a unified way referral criteria and procedures; increase the relevant departments and improve community health service network, improve the ability of medical services; binding and to guide efforts to increase patients; communication and collaboration, and promote two-way referral. Research innovation and lack of innovation of research: the study from the point of view of health insurance, the analysis of the problems faced by the two-way transfer to the clinic, the shortcomings and stakeholder analysis to analyze the various stakeholders in the two-way referral process utilization of resources, position, focusing on analysis of the important role of the basic medical insurance, and on this basis, policy recommendations put forward the present predicament. The lack of research: due to the limitations of time and money, on-site investigation only in Zhuhai City, Guangdong Province, surveys, research projects may be insufficient representation of results. In the course of the investigation, the health insurance sector, the person in charge of the General Hospital, in charge of community health service institutions and doctors interviewed but did not take full advantage of the interview results may not fully reflect the two-way referral of community health service institutions and the General Hospital factor. In the investigation of two-way referral running sluggish reasons, the corresponding policy recommendations, but not specific, not comprehensive.

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CLC: > Medicine, health > Preventive Medicine,Health > Health care organizations and career ( Health Management ) > Health care systems and institutions > Health care system
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