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Table 3 Policy changes before and after the implementation of the model

From: Evaluation of the effect of the capitation compensation mechanism among pulmonary tuberculosis patients with a full period of treatment

Index

Before

After

PTB classification

No

Ordinary PTB/PTB with comorbidities and complications/PTB pleurisy

Medical insurance payment

Fee-for-services

Compensation mechanism with a full period of treatment

Compensation plan

 Outpatient

Special diseases, according to hospitalization compensation

Outpatient (according to the norm standard, Table 2)

 Inpatient

Deductible is 600 RMB, The reimbursement rates for county, township, and village-level medical institutions are 50%, 55%, and 75%, respectively

Medical institutions outside the county are not reimbursed

Full period (according to the norm standard, Table 2)

Cancel the deductible and the non-reimbursable project expenses outside the medical insurance catalogue

70% reimbursement according to the norm standard

Cancellation and project expenses and deductible health insurance directory can not be reimbursed

Billing plan

 Medical institutions and medical insurance institutions

Hospital compensation amount = reimbursable expenses × reimbursement ratio

Reimbursable expenses = total medical expenses − non-reimbursable expenses − deductible line

Hospital compensation amount = fixed payment standard × reimbursement ratio (70%) × number of patients

 Medical institutions and patients

Patient out-of-pocket expenses = total medical expenses − hospital compensation expenses

Patient out-of-pocket expenses = total medical expenses × out-of-pocket ratio (30%)

 Assessment standard

No

Whether to implement according to the clinical path, if yes, all funds are allocated according to the service package payment standard; if not, 10% of the funds are deducted

  1. PTB Pulmonary tuberculosis