Abstract:

The spread of tuberculosis will bring negative externalities, while medical insurance payment methods can promote hospitals to actively control costs and reduce the burden on patients. Based on domestic and international experience, the author established a full-course capitation compensation bundled payment model that was in line with the characteristics of tuberculosis prevention and control. The full course of treatment was packaged according to disease type, the service package, its payment standard, and the total annual prepaid fund were calculated by the clinical pathways and historical data, to mobilize the enthusiasm of designated hospitals at all levels. The calculation results of the payment standard in Yichang City showed that this model was suitable for tuberculosis,which was conducive to controlling unreasonable medical insurance expenditures, improving fund efficiency, and regulating hospital diagnosis and treatment behavior by leveraging the leverage of medical insurance payments, thereby forming a people-oriented full-course and full-cycle health management model. Above all, this study will provide a valuable reference and reliable basis for the reform of tuberculosis payment methods in other regions and countries.

Key words: Tuberculosis, pulmonary, Rate setting and review, Prepaid health plans