"What are the ways of paying for health care"

The total prepayment system (globalbudget) is a system in which the total budget of a certain medical institution for a certain period of time (usually 1 year) is determined by a governmental department or an insurance organization, taking into account the services provided by the medical institution, according to certain criteria, such as the size of the institution, its technology, the number of people it serves, and the volume of services provided by the hospital (including outpatient visits, inpatient admissions and costs, etc.). This is the maximum amount that the health insurance organization will pay.

Capitation (capitation) according to the agreed number of hospitals or doctors to serve the population and per person prescribed fee quota, reimbursement of medical services in advance, so as to prompt the supply side to consciously take cost-control measures, such as disease prevention, health education, regular medical check-ups, and other activities, with a view to minimizing the incidence of disease, reduce costs and expenditures.

Payment by Disease Diagnosis-Related Groups (DRGs) is also known as Disease Diagnosis Classification-Prepayment System (DRGs-PPS). Since the 1970s, the United States has taken the lead in researching and establishing the Disease Diagnosis Related Groups (DRGs). That is, according to the International Classification of Diseases (ICD), hospitalized patients are divided into a number of DRGs according to their diagnoses, and each DRG is assigned a price, and the patient pays the hospital a one-time fee for that assigned price during the whole process of diagnosis and treatment. The principle is to make the very complex and random medical payment process standardized, the patient's diagnosis and treatment process as a whole, the hospital's income has nothing to do with the actual cost, but with each case and its diagnosis.DRGs is the international ideal case combination model, which integrally reflects the severity of the disease, the prognosis, the difficulty of the treatment, the intensity of the medical service and the degree of resource consumption. It is a relatively reasonable method of medical cost management and a relatively objective method of medical quality evaluation. In addition to the United States, countries such as Australia, Germany, and Argentina also use this as a major way of paying for medical expenses.

The post-payment system generally refers to the medical insurance side after the cost is incurred, according to the insured person with the actual incurred medical costs as the basis for payment to medical institutions. This payment system has long been used in China. Postpayment system mainly includes payment by service item and payment by service unit.

Payment by service item (feeforservice) refers to the medical service process designed to set the price of each service item, according to the medical institutions to provide services to the project and the number of medical services in the form of payment. This is our country has been used, but also the most widely used a kind of medical expenses settlement, belongs to the "post-payment system". The cost of service items is the most primitive cost basis for determining payment, and is also the basis for project costing, fee setting and adjustment. Although each project has a clear fee standard, but for each type of disease, the hospital in the end with what items, the entire diagnosis and treatment process should be used in which items, so far there is a lack of uniform norms.

Payment by service unit (serviceunit), also known as the average cost standard payment, is between the payment by project and payment by disease a form of payment. The average payment standard is calculated by sampling a certain percentage of outpatient prescriptions and hospitalized medical records and deducting unreasonable medical expenses. It breaks down each hospitalization of a patient into daily or other units for payment.