Empowerment Mechanisms and Empirical Evidence of Payment Technology in Capacity Expansion and Quality Improvement of Residents’Consumption

The time-varying difference-in-difference model is used to identify the impact of payment technology on residents’consumption,and the moderation effect analysis method is used to identify its mechanism.It is found that payment technology promotes consumption capacity expansion and quality improvement(CEQI)through three pathways of alleviating liquidity constraints,reducing transaction costs and weakening the payment of pain.The parallel and serial mechanisms of the three are further explored.The effect of payment technology on the CEQI of residents’consumption shows obvious heterogeneity due to differences in urban and rural household registration and financial literacy.Based on the empirical research results and the national conditions of China,targeted policy recommendations are proposed from the demand side,the supply side and the technological side.

A Note on a One-Parameter Weibull Distributed Deteriorating Item EOQ Inventory Model with Varying Quadratic Demand and Delay in Payments

In this paper, an EOQ inventory model is developed for deteriorating items with variable rates of deterioration and conditions of grace periods when demand is a quadratic function of time. The deterioration rate considered here is a special type of Weibull distribution deterioration rate, i.e., a one-parameter Weibull distribution deterioration rate and it increases with respect to time. The quadratic demand precisely depicts of the demand of seasonal items, fashion apparels, cosmetics, and newly launched essential commodities like android mobiles, laptops, automobiles etc., coming to the market. The model is divided into three policies according to the occurrence of the grace periods. Shortages, backlogging and complete backlogging cases are not allowed to occur in the model. The proposed model is well-explained with the help of a simple solution procedure. The three numerical examples are taken to illustrate the effectiveness of the EOQ inventory model along with sensitivity analysis.

Digital Payment Systems in Urban Media Landscapes:The Evolution and Impact of Apple Pay on Urban Life and Consumer Behavior

This study examines the transformative impact of Apple Pay on urban landscapes and socioeconomic frameworks,with a particular focus on spending patterns and retail dynamics in metropolitan areas.By evaluating the adoption levels,the technological support,and the social impact of Apple Pay,the study shows that the service is both a catalyst for the development of digital payment and a sign of an increasing social gap.Although it has rapidly transformed Retail Enterprises and supported the construction of smart cities,especially in major world cities such as New York,London,and Tokyo,the work has brought out notable digital divides.Although Apple Pay,with more than 75%of iPhone users and 9,000 banks in 60 world areas and regions,has impacts that are not the same across urban populations,the study shows that while large format retailers have effectively adopted Apple Pay for value-added services to consumers and enhanced payment efficiency,small businesses encounter significant barriers in implementation.Additionally,the technology leverages smartphone usage and banking relationships,which does not address considerable urban population demographics and deeper issues of technology exclusion and inequality in the contemporary city.Such results call for attaining a just society’s technological advancement for efficiencies while still catering to all groups of urban dwellers.

基于同病同价思想的中医DRG支付政策推行探究

随着疾病诊断相关分组(DRG)支付方式改革在全国推行,如何将DRG应用到中医病种中成为急需解决的重点问题。虽然目前我国中医医疗机构可暂不实行DRG支付方式,但结合我国现阶段政策导向与工作进程,DRG支付方式改革与中医病种结合已成大势所趋。为探究DRG支付方式改革后续与中医病种结合发展的可行性,对DRG支付方式在中医病种推行的现状与困境进行梳理,基于同病同价思想并结合中医文化理念探讨DRG支付方式与中医病种结合发展、共同推进的政策可行性,以期为进一步探索符合中医药特点的医保支付方式提供理论支持。

第三方支付方式下某公立医院财务对账关键问题与对策探析

公立医院引入第三方支付方式以提升患者就诊体验,但大型公立医院存在收入类型多、核算单元多和跨院区核对滞后等问题,导致第三方支付方式下财务对账工作面临巨大挑战。根据郑州大学第一附属医院财务管理实践经验,在对医院第三方支付现状进行分析的基础上,发现当前医院财务对账存在退费风险加大、单边账问题突出和手工对账效率低等关键问题。进一步提出优化对账岗位层级化、更新会计科目合理化、提升对账系统智能化的应对策略,为第三方支付方式下大型公立医院财务对账工作提供参考,以提升公立医院运营管理效能。

中医优势病种DRG付费:政策、难点及对策

目的:分析各地中医优势病种DRG付费政策,为推进医保支付方式改革提供实证参考。方法:通过政策梳理和案例研究,分析中医DRG付费政策的实施成效及难点,提出对策建议。结果:各地中医DRG付费政策差异较大,存在中医优势病种概念不明、基层医疗机构覆盖不足、治疗质量考核规则不统一、病种遴选机制有待完善、医保-医院协同有待加强等难点。结论:加强部门协同,鼓励医院深度参与中医DRG付费;扩大政策覆盖范围,加大基层倾斜力度;精准界定中医优势病种,完善质量考核规则。

DIP支付方式改革对医疗机构的影响研究——以上海市某区为例

目的 评估医疗机构按病种分值付费(Diagnosis-Intervention Packet,DIP)支付方式改革前后的变化,分析医疗机构面临的挑战,为进一步完善DIP支付方式改革提供参考。方法 通过文献分析、关键知情人访谈等方法获取数据,并采用χ^(2)检验、Wilcoxon秩和检验和t检验进行统计分析,围绕医疗机构医疗服务能力、医疗服务效率、医疗质量安全、患者费用控制4个维度进行研究。结果 在实施DIP支付方式改革后,医疗服务能力方面的病例组合指数虽无明显变化,但较改革前试点医院的三、四级手术占比有所上升;医疗服务效率方面,平均住院日和床位使用率与改革前比较,差异无统计学意义(P>0.05);医疗质量安全方面,低风险组死亡率、Ⅰ类切口手术部位感染率明显下降;患者费用控制方面,住院次均费用上升趋势有所减缓,药品费占比有所下降。结论 为进一步完善与落实DIP支付方式改革,医保有关部门需要完善医疗质量评价体系,重视医疗机构参与性;保证医疗质量规范医疗行为,加强临床路径精细化管理;实施动态弹性管理策略,因地制宜设置DIP实施细则。

县域医共体医保总额付费效果研究

目的:评价县域医共体实施医保总额付费的政策效果,为推动医疗保险与县域医共体的联动改革提供参考。方法:运用双重差分法,从医疗费用、分级诊疗、医疗质量、医保支出、个人负担五个层面评价县域医共体医保总额付费的效果。结果:与非试点地区相比,试点地区医共体的次均门诊费用和医疗费用自付比例分别降低了15.141元和8.819个百分点,门诊医保基金支出比例和下转转诊率分别提高了12.419个百分点和1.539个百分点。结论:县域医共体开展医保总额付费能够提升患者控费意识,减轻患者疾病经济负担,促进医保基金有效使用,推动分级诊疗制度发展;但也存在改革进展滞后于医共体发展的困境,需因地制宜,完善县域医共体医保支付方式,建立与其适应的配套政策。

整合型健康服务组织医保支付模式的设计——基于中美比较

美国的健康管理组织(如HMO、ACO、PCMH)开展医保与医疗的深度整合,以效率为导向的医保支付设计兼顾费用控制、医疗质量、医防融合与患者流向引导,在世界范围内具有批判性借鉴意义。我国的整合型健康服务组织(如深圳罗湖城市医疗集团、三明尤溪县域医共体、天津基层数字健共体)的医保支付模式,在费用控制、服务质量、分级诊疗方面都有良好表现,但在提升患者体验、改善人群健康方面略显不足。未来的医保支付应以健康产出为引领,从总额控制转向疾病精细管理,基于循证医学证据探索慢性病目标制绩效支付方式。

医养结合服务支付:长护险与医保的政策边界与协同路径——基于上海市的实践样本分析

医养结合是一项跨领域的政策实践,其服务的有效获取离不开相关支付政策的协同支持。长护险和医保是医养结合服务支付体系中两项重要的政策,但二者在医养结合支付实践中存在内容交叠、待遇差距大、衔接不畅等问题,严重制约医养结合服务的高质量供给。鉴于此,基于政策协同理论,从政策协同目标、协同层次、协同内容,以及信息协同等方面提出促进二者在医养结合支付中有效衔接的路径及建议,包括确立以老年人获取高质量、连续性的医养结合服务为共同目标,厘清二者的支付边界,建立统一的医养结合支付体系,建立多方信息共享机制等,以此实现政策协同效应的最大化,推动医养结合服务的有序开展。

医保支付改革视角下DRG成本核算若干问题及建议

在医保支付改革中,高质量的DRG成本核算至关重要。当前,DRG成本核算存在分组器等核心逻辑不透明、没有扣除财政基本拨款收入形成的各项费用、成本核算方法选择困难等问题。对此,各地医保部门应尽量公开DRG分组器和支付标准,提高透明度和公平性,强化监管和审核,并建立反馈机制;基于制定支付标准的目的,DRG成本核算应扣除财政基本拨款收入形成的各项费用,形成精准的成本数据;精益化开展基于项目叠加法的DRG成本核算。

DRG支付对住院患者医疗费用负担的影响研究

目的:分析DRG支付对住院患者医疗费用负担的影响,助力我国医保支付方式的深化改革。方法:以2020—2022年江苏省常州市30家医院的医保住院患者为样本,采用双重差分模型,实证分析DRG支付前后住院患者医疗费用负担的差异。结果:实行DRG支付后,试点医院住院患者的医疗费用总额和个人账户自付金额分别下降了12.1%和11.2%;耗材费和药品费分别下降了17.1%和18.9%;城镇职工医保患者的医疗费用负担低于城乡居民医保患者,年龄越大的患者医疗费用负担越重;三级医院的降费减负效应强于二级及以下医院。结论:DRG支付具有显著的降费减负效应,其作用的着力点是降低了耗材费和药品费;在遵循我国医改顶层设计的基础上,应加快推进DRG支付方式改革,根据医院等级分层次探索匹配的DRG支付方式,同时关注患者的个体特征。

中国家庭婚姻支付的变动趋势、城乡差异与地区模式(1978—2018)

基于中国健康与养老追踪调查(CHARLS)数据库中涉及婚姻支付的数据,对改革开放40年来(1978—2018年)中国家庭婚姻支付的变动趋势、城乡差异和地区模式进行了分析。结果显示,城镇地区彩礼和嫁妆的发展比农村地区更为均衡,城镇地区彩礼和嫁妆上涨趋势基本一致,而农村地区2000年以后彩礼增长速度远超嫁妆,农村地区彩礼快速增长给家庭带来的经济负担大于城市地区。根据各地区城乡的彩礼金额和彩礼与嫁妆的比值,用K-means聚类分析方法分别划分26个地区的城镇和农村婚姻支付模式,可将婚姻支付模式划分为“非均衡式高彩礼”“非均衡式中等彩礼”“均衡式中等彩礼”和“均衡-非均衡式低彩礼”“均衡式高彩礼”(城市地区独有)5种类型。不同婚姻支付模式中的彩礼和嫁妆给家庭带来的经济负担不同,未来应从彩礼与嫁妆并行的角度分析“天价”彩礼的成因。

TAM-based Study on Factors Influencing the Adoption of Mobile Payment

This study uses TAM to examine the factors that influence the adoption of mobile payment in China.The proposed model is empirically evaluated based on TAM by using data collected from 370 users concerning their perceptions of mobile payment.The findings indicate that perceived usefulness and perceived ease of use have significant effects on users'attitude.Furthermore,network externality is also an important factor influencing the adoption.But customers have weak perceptions of the risks of M-payment.The results may provide further insights into mobile payment strategies.

第三方支付领域的行政合规管理

鉴于我国现有的第三方支付领域仍旧采取高权型行政监管模式,不仅可能阻滞第三方支付领域的整体行业发展,而且也会妨碍行政监管的目标达成。经由分析行政机关推动企业合规管理的制度动因和优势,由行政机关引导企业建立风险导向型的合规管理模式,实现第三方支付行业中反洗钱、反垄断和信息保护等特定领域的专项风险防控,是行政合规应用于第三方支付领域的重要治理逻辑。据此,探索行政合规管理应用于第三方支付领域的具体规制路径,需要着眼于革新行政监管模式的原则理念,促成行政指导、行政强制和行政激励等行政合规方式的体系应用,以及积极引导第三方支付机构建立行之有效的专项合规制度。

“月支年结”:压力型体制下建筑业农民工工资支付逻辑分析

在压力型体制下,建筑业农民工按照“月支年结”的方式获取工资。该支付方式是用人单位、农民工与政府职能部门三方主体相互妥协的结果,其微观运作逻辑:用人单位压缩人工成本,缓解资金短缺;农民工劳动力再生产成本低,议价能力弱,信赖压力型体制;政府职能部门关注工资最终支付结果,对工资支付方式的监管力度不足。压力型体制能相对保障农民工在年末、季末获得足额工资,但并没有达到根治欠薪的目的,也未能完全维护农民工的劳动权益。

中国式现代化进程中的金融强国战略与人民币国际化——数字人民币与多边支付系统双核心分析

在国际金融体系中,一国货币的国际化水平与其在全球经济格局中的地位息息相关。文章提出了一种以数字货币人民币与多边支付架构并重的“双核心”战略,旨在强化人民币的国际地位,通过建构技术规范、完善法律法规体系、推进金融机构协作、强化支付企业角色、建立跨境支付示范区以及增强国际金融中心支持力度,全方位推动人民币国际化进程。文章深入剖析了数字人民币与多边支付体系间的协同影响,并着重指出人才培育对于创新驱动的关键性,以此保障支付体系的效能与安全性。实现金融强国的目标,“双核心”战略实为一条关键途径,能够有效地强化我国在全球金融体系内的竞争力和影响力,为中国式现代化的全面推进提供有力支持。

Evaluation of the inclusive payment system based on the diagnosis procedure combination with respect to cataract operations in Japan------A comparison of lengths of hospital stay and medical payments among hospitals

Following the recommendations of a report submitted by the Central Social Insurance Medical Council concerning the 2002 revision of the Medical Service Fee Schedule, a new inclu-sive payment system, which is based on the Diagnosis Procedure Combination (DPC) sys-tem, was introduced in 82 special functioning hospitals in Japan, effective beginning in April 2003. Since April 2004, the system has been gradually extended to general hospitals that satisfy certain prerequisites. In this paper, the new inclusive payment system is analyzed. Data pertaining to 1,225 patients, who were hospital-ized for cataract diseases and underwent lens operations from July 2004 to September 2005, are used. The lengths of hospital stay and medical payments among hospitals are com-pared. Even after eliminating the influence of patient characteristics, there are large differ-ences among hospitals in average lengths of hospital stay and DPC-based inclusive pay-ments. The highest average inclusive payment is 3.5 times as high as the lowest payment. On the other hand, there are relatively small differ-ences in non-inclusive payments based on the conventional fee-for-service system—the larg-est deviation from the average of all hospitals is approximately 10%. Thus, although payments based on the DPC account for only one-third of the total medical payments for this disease, the major differences in medical payments among hospitals are caused by differences in their DPC-based inclusive payments. The results of the study strongly suggest that revisions of the payment system in Japan are necessary for the efficient use of medical resources in the future.

Analysis of inpatient payments of breast cancer patients with different medical insurance coverages in China(mainland) in 2011–2015

Objective： An understanding of the levels and trends of medical cost is made for breast cancer patients with different medical insurance coverages in China（mainland）, in an attempt to offer a clue to further control the costs.Methods： The inpatient payments of 9,716,180 breast cancer patients spent in medical institutions of different types and grades during 2011–2015 were collected from the inpatient medical record home page（IMRHP） dataset.The data were then processed with SAS（Version 9.3; SAS Institute, Cary, NC, USA）. Indicators like means,increase（decrease） percentages were used to descriptively analyze the average hospitalization expense of each time（AHEET） and its trends of breast cancer patients with different medical insurance coverages treated in medical institutions of different types and grades.Results：In 2011–2015,the AHEET borne by breast cancer patients in China had been constantly increasing.Specifically,the self-pay inpatients had the largest increase,inpatients covered by Urban Employee Basic Medical Insurance（UEBMI）and Urban Resident Basic Medical Insurance（URBMI）were the next,and those covered by New Rural Cooperative Medical System（NRCMS）had the least increase.Breast cancer inpatient treated in public hospitals had quite greater increase and higher expenditure level than those in private hospitals.The AHEET borne by the inpatients in Grade 3 hospitals had greater increase and higher cost than those in Grade 2 hospitals.Conclusions：The inpatient payments of breast cancer patients will be wisely controlled by reducing the number of self-pay inpatients,taking advantage of restriction mechanism of the medical insurances,and promoting healthy competition between private hospitals and public hospitals.The economic burden imposed on the society by breast cancer can be relieved through further control of inpatient payments of UEBMI-and URBMI-covered breast cancer patients and of Grade 3 hospitals.

Effects of Integrated Case Payment on Medical Expenditure and Readmission of Inpatients with Chronic Obstructive Pulmonary Disease： A Nonrandomized, Comparative Study in Xi County, China

In the past few decades, Chinese government attempted to reduce the economic burden of chronic diseases and lower family financial risk of patients by establishing a nationwide coverage of Social Health Insurance system. However, the payment mode of Social Health Insurance varies across Chinese healthcare settings, and the effectiveness of each mode differs. This study aimed to evaluate the effects of integrated case payment on medical expenditure and readmission of inpatients with chronic obstructive pulmonary disease （COPD）, a complex, multicomponent, chronic condition. A nonrandomized, comparative method was used in this study. Inpatients with COPD before （n=1569） and after the integrated case payment reform （n=4764） were selected from the inpatient information database of the New Cooperative Medical Scheme Agency of Xi County. The integrated case payment comprises the case payment （including price-cap case payment and fixed-reimbursement case payment） and clinical pathway （including clinical pathway A, clinical pathway B and clinical pathway C）. Effects of integrated case payment were evaluated with indicators of per capita total medical expense and readmission within 30 days. A multivariate linear regression and a binary logistic regression were used to conduct statistical analysis. The results showed that case payment, comprising price-cap case payment （β=2382.988, P〈0.001） and fixed-reimbursement case payment β=2613.564, P〈0.001）, and clinical pathway C （β=1996.467, P〈0.001） were risk factors of per capita total medical expenses. Clinical pathway A （β=-1443.409, P〈0.001） and clinical pathway B （β=-1583.791, P〈0.001） were protective factors. The interactive effects of case payment with hospital level （β=0.710, P〈0.001） lowered the readmission rate within 30 days. Meanwhile, clinical pathways A （β=18.949, P〈0.001）, B （β=-19.752, P〈0.001） and C （β=-1.882, P〈0.1） were associated with the rate increase. The findings revealed that integrated case payment ensured the quality of care for inpatients with COPD to some extent. However, this payment mode increased the per capita total medical expense. Further, policy-makers should set reasonable reimbursement standards of case payment, unify the type of case payment, and strengthen the supervision of the reform to enhance its function on medical cost control.