According to the basis of determining the budget amount, the total advance payment can be divided into total advance payment determined by historical consumption, total advance payment determined by work content, total advance payment determined by employees, total advance payment determined by service quantity and total advance payment determined by service provider's performance.
Advantages: the hospital will actively reduce the service cost, management cost and operation cost, and improve the efficiency of resource utilization; The cost control effect is good, the management cost is low, the expenditure is predictable and the medical insurance premium can be "balanced". The cost settlement is simple, and the medical service provider becomes the controller of medical expenses at the same time, which is beneficial to the macro-control of medical expenses and reduces the management cost.
Disadvantages: the budget standard is difficult to determine. Excessive budget will lead to unreasonable growth of medical service supply; Low budget will harm the economic interests of medical service providers and patients.
If the supervision is weak, it will also lead to the blind cost saving of medical service providers, restrain the reasonable medical demand of demanders, and lead to the decline of service quantity and quality. Paid service (FFS) means that doctors and other medical personnel receive different remuneration according to the type and quantity of services provided to patients (such as diagnosis, X-ray examination, surgery or other services).
In this payment method, doctors and other medical personnel charge service fees according to the pre-agreed price, which is actually a disguised piece-rate wage system. It belongs to the "post-paid system".
Advantages:
Charging by service can encourage doctors to increase the number of medical services, extend working hours and accept more patients. The system is easy to implement and can accurately reflect the work and consumption of doctors. Usually, patients who don't have to bear or bear little medical expenses are satisfied with this system.
Disadvantages:
First, the more services provided, the higher the income, which will stimulate designated medical institutions to provide excessive services and high-priced services, and even decompose project fees and repeated charges, resulting in unreasonable growth of medical expenses.
Second, due to the wide variety of medical service charges, medical insurance institutions must review, register and pay one by one, so this payment method has a very heavy workload and high management cost. Third, under this payment method, medical institutions lack the awareness of cost control and compete to introduce cutting-edge diagnosis and treatment equipment, which is easy to waste medical resources. Per-head payment means that the payer pays a fixed fee to the health institution in advance according to the scale, technology and characteristics of the clients of the health institution and the payment standard of each client (person) and service population, and the provider is responsible for providing the health services designated by the payer to the target population.
If the total cost of services provided by health institutions exceeds the total payment, the economic risk shall be borne by the provider. This is a prepaid way. This method is adopted by HMO in America and general practitioners in Britain.
Advantages: the method is simple and easy to operate, and both medical insurance institutions and designated medical institutions are easy to operate. In this way, the total income of the hospital is in direct proportion to the total number of people it serves, which can encourage providers to actively reduce the service cost and prevent over-service.
If the target population is fixed, it can also improve the enthusiasm of health institutions to carry out preventive health care services. Therefore, for the payer, it can not only effectively control costs, but also reduce management costs.
Disadvantages: the provider of medical service I may reduce the necessary service content or quality in order to save money and refuse seriously ill patients; The hospital lacks the sense of competition, and the medical staff does not improve the enthusiasm of medical technology.
According to the International Classification of Diseases (ICD-9), diseases are divided into several groups according to different ages, genders and diagnoses. Combined with evidence-based medicine (EMB), the payment standards of medical expenses in each group are calculated through clinical channels and paid to medical service institutions in advance.
Advantages: the cost compensation is paid in advance according to the classification and registration amount of each patient's disease, so the income of the hospital has nothing to do with the actual cost of the disease. It is an effective way to control medical expenses internationally at present.
By forcing medical service providers to share economic risks, induced demand and unreasonable medical expenses can be reduced.
Disadvantages: the severity of the patient's disease and the consumption of actual medical resources are not considered. Hospitals may reduce costs by refusing to accept critically ill patients, reducing necessary examination and treatment procedures, and reducing service quality. They may also get multiple compensations for repeatedly diagnosing the same case. Moreover, the treatment cost of various diseases is complicated, which requires a complete information system and high management cost. Payment by service unit, also known as average cost standard payment, belongs to the "post-payment system" type and is a form of payment between payment by project and payment by disease. The average payment standard is calculated by extracting a certain proportion of outpatient prescriptions and inpatient medical records and deducting unreasonable medical expenses.
Advantages: it is beneficial to the hospital to curb unnecessary services and drugs, reduce medical costs and increase income; The expense settlement procedure is simple; Patients have easier access to various medical services.
Disadvantages: the hospital artificially decomposes outpatient prescriptions or hospitalization times, increases outpatient visits and prolongs the hospitalization days of patients; Because the total amount of services in the unit is out of control, excessive or insufficient services can easily lead to the total amount of medical expenses out of control; The number of patients seeking medical treatment has increased, the length of hospitalization has been prolonged, and the phenomenon of "expensive medical treatment" has appeared.