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Medical Insurance System and Tiered Medical Service System(Special Issue No.30, 2017)


By Yu Dong & Ge Yanfeng, Research Team on “The Improvement of Tiered Medical Service System”, Research Department of Social Development, DRC

Research Report Special Issue No.30, 2017 (Total 1554) 2017-07-28

Abstract: The core function of medical insurance system in tiered medical service system is to constrain both the supply-side and the demand-side and set a norm on medical fees so as to achieve smooth macro-performance. However, the role of China’s medical insurance system in tiered medical system has not been brought into full play due to the fact that the insurance system did not nail down the real targets, the system failed to leverage the incentives and restraint factors to the supply side and the demand side, some reform measures are lopsided and the reform momentum is relatively weak. In light of China’s case, there are mainly two reform approaches. First, we need to continue to follow the basic principle of strengthening medical and health care at the community level. Second, the medical service within the same region needs to be based on a payment arrangement of capitation and the medical staff and medical facilities need to be managed in an integrated manner. The initial reform measures include risk pooling of outpatient services and contracted family doctor service system. Through reforming the mode of payment and enhancing the doctors’ incentives at the community level, efforts need to be made to gradually restrain the large hospitals from conducting general outpatient services and inpatient care of complicated and serious diseases and flesh out the disease classification standards and emergency specifications.

Key words: tiered medical service system, medical insurance system, reform approaches, to make trial practice of reform