Research on Obstacles to Segmented Reimbursement of Medical Insurance in Tight City Medical Groups Based on Grounded Theory
Objective:To analyze the obstacles of medical insurance package payment and segmented reimbursement in compact urban medical groups,and provide reference basis for the implementation of medical insurance policies. Methods:Using grounded theory for topic coding,and conducting analysis of variance to investigate whether economic factors lead to differences in hindering factors. Results:The coding results obtained 4 core categories,9 main categories,and 30 sub categories,with the core categories being top-level design,execution ability,allocation of rights and responsibilities,and supervision. The results of the analysis of variance indicated that the level of economic development did not lead to significant differences in hindering factors. Conclusion:To overcome the obstacles to medical insurance reform,government departments,as leaders,should play a good role in the policy combination blow. Medical groups should establish a unified information platform,facilitate dual-way referrals and establish incentive and constraint mechanisms. Medical institutions should refine cost management,optimize performance evaluation plans,improve medical insurance business financial management,etc.,to promote the reform of medical insurance payment methods,and to promote the improvement and development of hierarchical diagnosis and treatment.
tight urban medical grouprooted theorysegmented reimbursement of medical insurancemedical insurance package payment
万方数据
维普
