Internet Health Care Incorporated into Health Care Will Speed Up Outpatient Payment Reform

With the integration of Internet medical care into health insurance, the health insurance payment system has put forward a greater challenge, this challenge is not only in the supervision of services, but also on outpatient payment will create greater pressure, which in turn will promote the health insurance outpatient payment system to speed up the reformAlthough health insurance on the Internet medical system to implement the principle of online and offline consistency of supervision, its medical insurance quota must also come from offline medical institutions, but the Internet with its convenience more easily induce users to carry out unnecessary medical consumptionFor example, according to a 2015 rand company comparison of 1,725 patients who used Teladoc and 64,099 online patients, the main users who used remote consultations were under 51 years of age withno chronic diseasesThe proportion of prescriptions issued is consistent online and online, and more broad-spectrum antibiotics are prescribed online, which is due to doctors not particularly aware of the patient's conditionFrom this early study, it can be seen that telediagnosis in the United States is mainly for young and middle-aged people to have easier access to prescription drugs, especially antibiotics, and more as part of the company's drug benefits (Teladoc's main customers charge corporate membership fees)for a long time, the problem of outpatient abuse has been a national health care concernUnlike hospitalization, although the average cost of outpatient medical expenses is not high, but due to the high frequency, led to a sustained increase in the proportion of outpatient expensesIn order to control the rapid rise in outpatient costs, it is generally restricted by setting up the starting line, capping line and increasing the out-of-pocket ratioHowever, with the improvement of economic development level and the convenience of medical visits, the frequency of user visits continues to rise, such as japan's annual average number of visits reached 13, Taiwan is more than 15Internet health care will accelerate the process, which is also the pressure on the sustainability of already tight health care fundstherefore, speeding up the reform of the outpatient payment system will be the next priority after the reform of the DRG payment systemAt present, although hospitalization is still the core of medical insurance payment, especially urban and rural residents' medical insurance hospitalization costs accounted for 84% of total expenses, significantly higher than the 61% of workers' health insuranceHowever, with the start of the DRG payment, due to the packaging of fixed payment, the average cost of individual cases will be reduced, in order to meet the requirements of a fixed amount, the hospital will be the cost of hospitalization to the pre-hospital and post-hospital transfer, especially the pre-hospital examination to the outpatient, after discharge outpatient clinic will also appear significantly increasedon the other hand, urban and rural residents' medical insurance has been cancelled, urban workers' medical insurance account will be gradually reduced, and outpatient co-ordination will be the focus of the next developmentAs the outpatient co-ordination is pushed away, the increase in outpatient costs will continueif the triple impact of Internet medical care, outpatient co-ordination and DRG reform is taken into account, health insurance spending in outpatient care will increase significantly next, and the reform of outpatient payment system will have to be acceleratedin-patient payment will form a DRG-based hybrid payment model, but outpatient payments will continue to be paid mainly by item, supplemented by head payments Pay-per-head has a relatively large limitation in itself, requiring a stronger general practitioner and compulsory referral system In areas where there is no compulsory referral, especially in areas where GP capacity is weak, it is generally difficult to pay for the head Therefore, learning from the successful experience of pay-per-view in universal health-care countries remains critical In practice, the use of points method in the field of outpatient clinics in medical insurance-based countries and regions has been relatively successful, and the effect of controlling medical expenses is better points method is from the actual situation of the health insurance fund, after determining a total amount to remove the total amount of services for the whole year, to obtain a point value, and then based on the number of points of each disease to determine the actual amount obtained Moreover, the points method is based on total control, there will be no over-the-end phenomenon points method is divided into floating and fixed two, the advantage of floating point method is that medical institutions can not know the value of specific points until the end of the year, can not be in advance according to the specific value to induce or refuse service, effectively avoid the problem of inducing hospitalization or pushing patients However, the floating point sore method also has drawbacks, floating points method will lead to medical service institutions and doctors blindly expand the volume of services, is not conducive to the control of medical quality fixed points method is agreed value of points in advance, but often the hospital and doctors set a total budget limit, the excess will be controlled, generally reduced or not paid, with the different medical behavior of positive and negative incentives The trend in overseas markets is that the fixed points method gradually replaces the floating point method, but there is a positive and negative incentive for excess of fixed points The points law was first implemented in Germany, in 1977, Germany enacted the Medical Expenses Control Act, which provides for the relative value of each medical service points, initially using the floating points method, the state disease fund associations and physicianassociations in previous years on the basis of the total medical expenses to negotiate the determination of the total amount of payments, each point value by the total budget divided by the total number of points to determine The value of points declined rapidly in the 1990s because of the rapid growth of services To mitigate the decline in the value of points, in 1998 Germany introduced a single doctor's "medics payment budget", which limits the maximum number of services provided by a doctor over a single quarter, i.e the number of points, and the excess will be paid at a lower price the Statutory Health Insurance Enhanced Competition Act, passed in 2007, requires health care items to be paid no longer at floating points but at fixed euro pointvalues, but at a discount on health services outside the limit At the same time, Germany has raised the overall level of health insurance to the whole country, which will help to change the uneven distribution of medical payments, solve the problem of inadequate health insurance funds in some areas, and also help to eliminate the differences in the value of points in different regions points method is a fine management tool, from the original through floating points to control the cost gradually changed to control the service volume through fixed points method, the main reason is to eliminate regional differences and ensure the quality of medical care However, in areas where compulsory referral is not implemented, it is not conducive to the development of grass-roots general practice, and is more conducive to the expansion of large hospitals from the trend of health insurance reform, the outpatient payment system will speed up the reform to adapt to the trend of medical expenditure to outpatient concentration However, from the experience of other countries and regions, if compulsory referrals cannot be implemented, outpatient clinics will continue to focus on large hospitals rather than to the grass-roots level, and the same principle applies to Internet medicine.