China Promotes Sanming's Model: A National Template for Integrated Medicare Payment Methods

Zhengdong Zhong; Qiang Yao; Shanquan Chen; Junnan Jiang; Kunhe Lin; Yifan Yao; Li Xiang

doi:10.5334/ijic.7011

China Promotes Sanming's Model: A National Template for Integrated Medicare Payment Methods

Int J Integr Care. 2023 May 11;23(2):15. doi: 10.5334/ijic.7011. eCollection 2023 Apr-Jun.

Authors

Zhengdong Zhong¹, Qiang Yao², Shanquan Chen³, Junnan Jiang⁴, Kunhe Lin¹, Yifan Yao¹, Li Xiang¹

Affiliations

¹ School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan, China.
² School of Political Science and Public Administration, Wuhan University, Wuhan, China.
³ Department of Psychiatry, University of Cambridge, Cambridge CB2 3EB, United Kingdom.
⁴ School of Public Administration, Zhongnan University of Economics and Law, Wuhan, China.

Abstract

Introduction: China is promoting integrated care. However, incomplete payment methods led to medical insurance overspending and intensified service fragmentation. Sanming implemented Integrated Medicare Payment Methods (IMPM) in October 2017, which integrates multi-level payment policies. Sanming's IMPM works well and has been promoted by the Chinese government. Therefore, in this paper, we aim to systematically analyze Sanming's IMPM, and conduct preliminary evaluations of Sanming's IMPM.

Policy description: IMPM integrates two levels of policy that are implemented simultaneously: (1) The payment policy for healthcare providers refers to how to calculate the global budget (GB) of the medical insurance fund paid to the healthcare providers and the policy guidance for the healthcare providers on how to use GB. (2) The payment policy for medical personnel refers to the adjustment of the evaluation index of the annual salary system (ASS) according to the IMPM's purpose and the payment policy that adjust pay levels based on performance.

Discussion and lessons learned: After the IMPM reform, county hospitals (CHs) may reduce over-providing dispensable healthcare, and cooperation between hospitals may increase. The policy guidance (Determining GB according to population; Medical insurance balance can be used for doctors' salary, cooperation between hospitals, and promotion of residents' health; Adjusting ASS assessment indicators according to IMPM purposes) increases CHs' motivation to promote balances of medical insurance fund by cooperating with primary healthcare and increasing health promotion actions.

Conclusion: As a model promoted by the Chinese government, the specific policies of Sanming's IMPM are better matched with policy goals, which may be more conducive to promoting medical and health service providers to pay more attention to cooperation among medical institutions and population health.

Keywords: Distribution of doctors’ salary; Global budget; Integrated Medicare Payment Methods; Medical insurance fund balance; Sanming model.

Grants and funding

This study was supported by the project of the National Natural Science Foundation of China. Funded projects are “The Study of Incentive and Restrictive Mechanism and Policy Optimization of Medical Alliance with Payment Method in the View of Value-Based Healthcare” (grant no.71874058) and “Research on the Incentive Mechanism of Point Method Global Budget System on County-level Value-based Healthcare Service System from the Perspective of Coopetition” (grant no.72174068). The funder supported us to complete the voucher investigation and article writing.