Research on the Bundled Payment Adjustment Mechanism for County-Level Medical Insurance Funds of Compact Medical Community Based on Health Economic Evaluation
Nong Sheng
Guo Yanhong
Wang Jian
Pan Yanjiang
Abstract：Objective:To establish a health economics evaluation-based adjustment mechanism for the medical insurance fund package in compact county-level medical community.Methods:A health risk assessment system was designed,with weights determined using the Delphi method.Population health risks were evaluated via rapid assessment methods to calculate health risk scores for each county(city,district),which were then used to determine the medical insurance fund package adjustment amount.Results:The county-level health risk evaluation index system encompassed four dimensions:health risk influencing factor,health protection resource,population health risk,and health level.Through information collection and field surveys,health risk scores for counties(cities,districts)in a case prefecture-level city were obtained,serving as a tool for allocating medical consortium package adjustment funds.Conclusion:The health economics evaluation-based medical insurance fund adjustment mechanism enhances the equity of total medical insurance fund allocation,activates the incentive role of medical insurance in healthcare delivery,and transmits intervention pressure to reduce residents'health risks to public management departments at the county level.This approach realizes mutual benefits among medical insurance,residents,and healthcare providers.
Keywords：health economic evaluationcounty-level medical communitymedical insurance fund bundlingadjustment mechanism
Publication Date：2025-06-05
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：6( 13-17,27 )