The Relationship and Mechanism of County Health Insurance Payment and Medical Service Structure Adaptation--Analysis Based on a Typical Case in Yun County

Corresponding author: zhangliang

DOI: 10.12201/bmr.202306.00005

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  Abstract: Synergy between health insurance and medical system is regarded as a key means to promote the optimization of health service system, and existing studies have neglected the synergy and reflection between the two subsystems. Taking Yunxian Medical Community as a research model, we construct a cross-system adaptation analysis framework of health insurance payment and medical services based on adaptation theory, longitudinally sort out the system adaptation paths and reveal the adaptation mechanism. The study finds that there are three main adaptation modes between the two subsystems, which show the characteristics of evolution to the next stage; the cross-system adaptation is a multi-factor adjustment process, and the subsystem adaptation status is non-reciprocal, showing a panorama of service priority change-adaptation of coverage, service structure change-medical insurance guiding behavior. This study is valuable for the reform of health insurance payment method adaptation with Chinese characteristics, and also contributes to the formation of useful experience in modernizing county health governance in Chinese style and promoting high-quality development of county health services in the new era.

  Key words: County; Health insurance payment; Medical service structure; Cross-system adaptation model; Adaptation relationship

  Submit time: 5 June 2023

  Copyright: The copyright holder for this preprint is the author/funder, who has granted biomedRxiv a license to display the preprint in perpetuity.
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