1. Optimize the process of medical treatment, improve the patient experience
Second, the background
1. In order to solve the people's difficulties in access to medical care, the problems of medical trouble, the former Ministry of Health, the "diagnosis and treatment and then pay" model, in 2013, the Zhejiang Provincial Department of Health to carry out the "commitment to practice the party line of the masses to facilitate people to benefit from medical services" activities, focusing on the 24 provincial and municipal hospitals in Hangzhou to publicly commit to the community to pay for the treatment of the people's health. In 2013, the Zhejiang Provincial Department of Health organized the "Practice the Party's public line to facilitate and benefit the people's commitment to medical services" activity, focusing on the requirements of Hangzhou 24 provincial and municipal hospitals to the public commitment to the community to hold Hangzhou People's Card and the provincial health insurance card for patients to provide "clinic settlement" services.
Third, the concept
1. Inter-diagnostic settlement, i.e., "consultation and settlement at the same time", is proposed in the original Ministry of Health, first diagnosis and treatment, then payment "based on the further transformation of the process of moving the payment link to the doctor's workstation, the patient's consultation and settlement of the consultation in the doctor's office, "a swipe card, two times. "The first time I saw this, I had to go to the hospital, and I had to go to the doctor's office, and I had to go to the doctor's office, and I had to go to the doctor's office, and I had to go to the doctor's office.
Fourth, the domestic "diagnosis and treatment, pay later the main program"
1. Program 1: based on the hospital's "pre-payment card" model.
Problems:
1.1 The card issued by the hospital itself, there is a policy risk, there is a suspicion of illegal fund-raising,
1.2 the lack of effective supervision, the cash is stored in the hospital rather than in the bank, there is no relevant legal protection
1.3 information can not be **** to enjoy the hospitals are not common between the hospitals, the patient is in different hospitals, need to apply for a number of cards, can not be truly done. "Option 2: Hospitals and banks cooperate in the "Silver Medical Card" model. The joint card issued by the hospital and the bank to realize the medical card and bank card unity,
Problem 1: patients are less willing to apply for an occasional use of the hospital-bank joint card
Problem 2: the joint card failed to bind with the medical card
Problem 3: the hospitals can not be common.
3. Option 3: City card model.
Problems: Can not be connected to the social security account, not a real sense of "city card".
Fifth, Zhejiang Province, "consultation settlement" main program
Zhejiang characteristics of the consultation settlement payment
1, citizen card "smart medical" settlement
Hangzhou Citizen Card has a record of information, identification, electronic credentials, query, and so on. Identification, electronic credentials, information query, electronic payment and other basic functions. It is applied to government applications represented by social security and convenient applications represented by electronic wallet.
The use of the process is shown in Figure 1, with the doctor's consultation settlement as the core, one insertion of the card, two settlements, and at the same time complete the settlement of the medical insurance card account and the citizen card self-financing account.
Advantages: 1. information to realize the **** enjoy, can be opened in the "smart health care" hospitals
2. Hangzhou Citizen Card support for the loss of the function
3. Citizen card and health insurance card into one, the integration of the health insurance and self-funding two kinds of payment functions, the patient to pay with a card
Disadvantages: Only those who hold Hangzhou municipal health insurance card can enjoy the service, and those who hold provincial health insurance card and self-funded patients cannot enjoy it.
2. Provincial social security card settlement program.
1. Design ideas: the provincial social security card loaded with a bank function of "a card with two cores", with both financial and diagnostic information functions
2. Advantages and disadvantages:
Advantages: because of the card has a financial function, the patient does not need to apply for a separate card, and can be recharged in the bank's major outlets.
Advantages: Because the card has financial features, patients do not need to apply for a separate card and can recharge it at major bank branches.
Disadvantages: First, the coverage is too narrow.
Second, the chip-loaded bank is not necessarily the hospital's cooperative bank
Third, it is difficult for patients to accept the chip on the social security card, and the vast majority of residents already have other bank cards
3. "Medical Bank Pass" settlement program
1. The patients of individual patients queuing up to pay, the use of clinic settlement and self-service equipment self-service settlement function to achieve. Patients can use the self-service equipment for self-service booking registration, recharge, payment, query, printing and other procedures, the use of real-time settlement between the consultation, greatly reducing the queuing time for patients to pay, convenient for patients to seek medical treatment.
2. Realization of the process: 1. Patients holding citizen cards, provincial social security cards, the original medical card, without the need to apply for a new card, only need to hold an ID card, through the system automatically generated virtual account (silver medical account) to be associated. Patients can settle in real time in the consultation room by recharging the account and binding a bank card, or through self-service terminal equipment. When the patient settles the bill, the medical insurance portion is deducted from the medical insurance account and the self-payment portion is deducted from the virtual account (medical bank account) through a single swipe of the card. At the same time, patients can choose to bind a bank card, without recharging the direct debit in the clinic, the patient's first visit to the hospital to the manual account to choose to bind a bank card (only support debit card) signing, as long as the debit card balance is sufficient in the future, you can realize the settlement of the clinic during the period of consultation, no need to recharge and no need to refund the third-party support company's cross-border collection and payment platform to achieve real-time debit in the clinic.
The specific process is shown in Figure 2:
3. Characteristics: 1. Patients do not need to apply for a new card (except for self-paying patients in the first visit), and with their second-generation ID cards, they can link their virtual accounts (i.e., medical bank accounts) with the virtual accounts generated through the Medical Bank Pass system on the self-service machines
and manage the recharge, settlement, balance, etc., of the virtual accounts. Supports a variety of payment modes, including recharge mode and bound bank card (collection and payment) mode. The recharge mode supports both cash and bank card transfer, and the bank supports all UnionPay debit cards.
3. The whole process is self-service, except for refunds, which need to go to the window.
4. Points to be improved:
1. The silver medical account of the medical bank pass patients is specialized in the transformation of the hospital's HIS. It can only be used within the hospital, and the hospital balance cannot be passed to other hospitals.
2. Patients who choose to bind the bank card mode, to other hospitals still need to be re-bound
3. Binding the bank card mode is realized through the third-party support company's qua bank's payment and collection platform, such as the failure to choose the UnionPay as the third-party payment company to support the settlement of a limited number of banks,
Six, the current stage of the better solution Solution (the thinking of sustainable development) )
1. Background: As the above three programs have very obvious shortcomings. In order to break down the barriers between various hospitals and systems, so that patients can enjoy fast medical services in various hospitals, to realize the true meaning of the card.
2. Solution: A third-party payment company needs to be established on the regional health information platform to collect and pay for the consultation settlement mode. Patients through the third-party support platform to bind any one bank card automatic debit mode, real-time settlement between hospitals, can also be through the self-service terminal equipment settlement ("a binding, how far applicable")
3. Specific procedures: social security patients with social security card in the third-party payment platform to complete the registration to achieve The social security card is bound to any bank. Self-funded patients are bound to their bank cards through their ID cards. When patients visit any hospital, they can realize consultation settlement through the third-party platform as long as they have sufficient balance. The flow chart is shown in Figure 3 below:
4. Key tasks to be coordinated.
4.1 ? Patients need to sign up with the third-party payment platform (paper is recommended) to recognize the spending in their designated bank debit card through the inter-bank collection and payment mode.
4.2 ? The hospital's HIS has been revamped. The use of inter-bank collection and payment function requires the hospital HIS to support inter-consultation settlement function, so the third-party support platform is required to cooperate with the HIS system to complete the transformation, development, docking and testing
4.3 Only a single three-party payment platform can be designated. In order to realize the patient's bank card balance **** enjoyment, the third-party payment platform needs to negotiate with the hospital and its cooperative bank, and choose it as the only third-party payment platform.
At the same time, the third-party payment company needs to increase its cooperation with banks to further expand the range of banks it supports.
5. Key challenges to overcome.
5.1 Who will bear the costs of the model?
Cost one, the cost of the inter-bank collection and payment model is high, with a single cost of $0.8-$1. This cost cannot be borne by the patient, and the third-party support company is a profit-seeking company, so there is a need to determine where the cost comes from and who pays for it.
Cost two, the hospital HIS system transformation costs are very high. It is necessary to determine the source and bearer of the HIS system transformation costs.
Methods to overcome this difficulty: Efforts to explore the establishment of a government-led, department-led, social participation, convenience and benefit to the public, cooperation **** win business model
5.2 Third-party support companies and hospitals and their partner banks are difficult to negotiate.
From the perspective of patient experience, patients signing up to bind a bank card function (i.e., collect-and-pay model) in one hospital can use it in all hospitals. This requires the third-party payment company to negotiate with each hospital and its partner bank. This is a difficult and time-consuming negotiation.
Ways to overcome this difficulty: We can coordinate the negotiation between the third party payment company and the banks through the relevant governmental departments to create a good institutional environment for cooperation***
5.3 Fee verification model.
The cross-border collection and payment model is generally agreed upon separately by the third-party support company and the banks to build the third-party platform's own cross-border collection and payment platform.
The special nature of inter-bank settlement, it is not recommended to enter a password on the way to settlement, UnionPay needs to require a password.
Although Alipay has access to a lot of banks, they are all online collection and payment modes, which can't meet the demand for offline support. And other third-party payment companies support a limited number of banks, can not support all the banks
The way to overcome this difficulty: this requires third-party payment companies to find more profit models, and actively expand their support banks.
Summary
Although it has alleviated the problem of "difficult to see the doctor" to a certain extent, there are still areas that need to be improved, such as acceptance by doctors, patient awareness, security of the account funds, compatibility of the diagnosis and treatment card, and cross-hospital universality.
PS: This study note is based on Dr. Ni Rong's article, "The Practice and Thoughts of "Inter-consultation Settlement" in Zhejiang Provincial Hospitals"
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