Design of Medical Insurance Payment Models for Integrated Health Service Organizations——Based on a Comparison between China and the United States
Health management organizations in the United States(such as HMOs,ACOs,and PCMHs)have carried out in-depth inte-gration of health insurance and healthcare,and their efficiency-oriented medical insurance payment design takes into account cost control,quality of healthcare,integration of healthcare and prevention,and guidance of patient flow,which is of critical reference significance in the world.The medical insurance payment models of integrated health service organizations in China(such as Shenzhen Luohu City Medical Group,Sanming Youxi County-level Medical Community,and Tianjin Primary Digital Healthcare Community)have performed well in terms of cost control,quality of service,and hierarchical diagnosis and treatment.However,there are slightly insufficient in enhancing patient ex-perience and improving population health.In the future,medical insurance payment should be led by health output,shift from total control to fine disease management,and explore the target-based performance payment method for chronic diseases based on evidence-based medicine.
integrated health service organizationmecdical payment modelhealth management organization in the United States
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