Associate Professor Yao Qiang from the Social Security Research Center of Wuhan University published a paper entitled "Research on the Settlement Process and Key Technologies of DIP Medical Insurance Fund" in the third issue of the CSCD journal China Health Policy Research in 2023.

【author】Yao Qiang,Zhang Xiaodan,Yao lan

【Published Journal】《中国卫生政策研究》

【Journal level】CSCD

【Publication Time】Issue 3,2023

【Abstract】How to settle the medical insurance fund under the payment according to the disease score in the regional total budget has become a major difficulty in the implementation of DIP. Through field investigation and policy literature analysis, this study established the logical framework and implementation process of DIP medical insurance fund settlement. The results show that the settlement framework with "fund pre-allocation", "monthly pre-settlement" and "annual settlement" as the core integrates the ideas of prepayment system and post-payment system. As a key link in settlement, "monthly pre-settlement" plays an important role in decomposing the year-end pressure of medical insurance agencies and medical institutions and guiding reasonable medical behaviors. "Annual liquidation", as the core link of settlement, determines the annual medical insurance fund payment amount of medical institutions, which needs to rely on and integrate key technologies such as regional total budget, disease score database and correction, and supervision and assessment of medical institutions; Through the introduction of settlement and related supporting policies, the settlement process, calculation methods and key parameters are clarified, so as to provide technical support and institutional guarantee for the implementation and effectiveness of DIP reform.

【Keywords】regional total budget; DIP； Settlement process; Medicare payment methods

【Funds】National Natural Science Foundation of China (72174149); Humanities and Social Science Research Planning Fund of the Ministry of Education(21YJAZH102); Key Research Base of Humanities and Social Sciences, Ministry of Education(1203-413100050)