The Relationship and Mechanism of County Health Insurance Payment and Medical Service Structure Adaptation--Analysis Based on a Typical Case in Yun County

Corresponding author: zhangliang

DOI: 10.12201/bmr.202306.00005

•  

  Abstract: Synergy between health insurance and medical system is regarded as a key means to promote the optimization of health service system, and existing studies have neglected the synergy and reflection between the two subsystems. Taking Yunxian Medical Community as a research model, we construct a cross-system adaptation analysis framework of health insurance payment and medical services based on adaptation theory, longitudinally sort out the system adaptation paths and reveal the adaptation mechanism. The study finds that there are three main adaptation modes between the two subsystems, which show the characteristics of evolution to the next stage; the cross-system adaptation is a multi-factor adjustment process, and the subsystem adaptation status is non-reciprocal, showing a panorama of service priority change-adaptation of coverage, service structure change-medical insurance guiding behavior. This study is valuable for the reform of health insurance payment method adaptation with Chinese characteristics, and also contributes to the formation of useful experience in modernizing county health governance in Chinese style and promoting high-quality development of county health services in the new era.

  Key words: County; Health insurance payment; Medical service structure; Cross-system adaptation model; Adaptation relationship

  Submit time: 5 June 2023

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

• 图表

• xuguangjian, qiaoyukun. Research on the linkage mechanism between the adjustment of medical service price and the reform of medical insurance payment mode in China. 2021. doi: 10.12201/bmr.202104.00018

  wanghogbo, zhangkairan, gongxi. The Collaborative Development of County Medical Communities and Health Insurance: Theoretical Reasons, Practical Dilemmas, and Optimization Strategies. 2023. doi: 10.12201/bmr.202310.00001

  Yang Fan. Research on the Influence of the Outpatient Security Level’s improvement on Medical Service Utilization and Medical Insurance Fund Expenditure -Based on the case analysis of Sanming City. 2021. doi: 10.12201/bmr.202107.00028

  Wei Jingming, Gao Qilong, Huang Minzhuo, Dong Hengjin. Study on the Operation Efficiency of County Medical Community in Zhejiang Province Based on DEA Model. 2021. doi: 10.12201/bmr.202005.00252

  haoqian, ZHANG Ping. Design and Implementation of Medical Insurance Supervision System Base on DRG Payment Mode. 2021. doi: 10.12201/bmr.202108.00018

  zhang shengjie, Cui Zhisheng, Lei Chao, Hu Dan. Integrating path of county level medical consortium from the perspective of actor-centered institutionalism. 2021. doi: 10.12201/bmr.202101.00016

  CHEN Yingcun, tanhuawei. Financial Vulnerability and Risk Protection of Health Insurance Payments in the Countys Healthcare Alliance: Risk Identification, Empirical Mirroring and Policy Pathways. 2022. doi: 10.12201/bmr.202212.00003

  Xiong Yingbei, Zhong Zhengdong, Lin Kunhe, Liu Xiao, Zhou Jin, Xiang Li. Research on the influence of internal and external economic incentives of Sanming county medical alliance on medical service supply. 2022. doi: 10.12201/bmr.202209.00006

  sunhuajun, zhangmeng, liuzhao, shendou, zhaokun, douyong, fengshiqiang, Liuyuehua. Reform Development Analyses and Policy Recommendations of County Medical Community --Based on Survey of 200 County Hospitals in 2019. 2020. doi: 10.12201/bmr.202007.00021

• ID	Submit time	Number	Download
  1	2023-02-22	bmr.202306.00005V1	Download

• Public  Anonymous  To author only Submit Comments