Financial Vulnerability and Risk Protection of Health Insurance Payments in the Countys Healthcare Alliance: Risk Identification, Empirical Mirroring and Policy Pathways

Corresponding author: CHEN Yingcun, 1039725514@qq.com

DOI: 10.12201/bmr.202212.00003

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  Abstract: Risk resilience is the key to high-quality and sustainable development of closely-knit county health care communities. Identifying the risk sources in the process of health insurance fund flow and risk transfer that may undermine the budgetary adequacy, payment effectiveness and settlement incentives of health insurance payments in compact county health care communities can effectively remove the financial vulnerability of health insurance payments in compact county health care communities. This paper first builds an analytical framework for the formation mechanism of health insurance payment vulnerability in tightly-knit county health care communities, and identifies the risks of eroding health insurance payment budget adequacy, payment compatibility and settlement incentives from multiple sources. On the basis of systematic research on the international experience of financial vulnerability risk protection of integrated healthcare organisations based on value and population-based payments, risk adjustment, risk corridors, and evaluation of the adequacy of health insurance payments, and taking into account the actual situation of health insurance payments in Chinas tightly-knit county health care communities, it is proposed to build a framework of budget adequacy risk protection (clarifying the scope of budget, scientific budgeting methods, and clarifying the boundaries of authority and responsibility of budget holders), payment Compatibility risk protection (multi-level hybrid payment that integrates value and population bases under the concept of incentive neutrality), settlement incentive risk protection (clear path of balance formation and transformation, quantified and optional risk thresholds, and risk sharing quality performance score linkage), and health insurance payment adequacy assessment as the core risk protection mechanism of financial vulnerability of health insurance payment in Chinas compact county health care communities.

  Key words: Municipal coordination; Countys healthcare alliance; Health insurance payment; Financial vulnerability; Risk protection

  Submit time: 12 December 2022

  Copyright: The copyright holder for this preprint is the author/funder, who has granted biomedRxiv a license to display the preprint in perpetuity.
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