PP548 The Design Of Long-term Care Insurance Payment: Base On Pilot Practice In Jingmen. (December 2020)

• Record Type: Journal Article
• Authors: Du, Tiantian; Yang, Junting; Li, Ying; Zhang, Meng; Liu, Yuehua
• Is Part Of: International journal of technology assessment in health care. Volume 36(2020)Supplement 1
• Page Start: 41
• Page End: 42
• Publication Date: 2020-12
• Subjects: Medical technology -- Periodicals; Technology assessment -- Periodicals; 610.28
• DOI: 10.1017/S0266462320001993
• Languages: English
• ISSNs: 0266-4623

Abstract

Abstract : Introduction: With the aging of population, miniaturization of family size and changes of diseases spectrum, the demand for long-term care of Chinese elderly is increasing, which is challenging the existing long-term care system. China is currently carrying out pilot work for a long-term care insurance system, and Jingmen is one of the pilot cities, however more detailed research on payment is needed. Therefore, this paper draws on case-mixed-adjusted prospective payment system to provide designs for long-term care insurance in pilot cities. Methods: Adopting a case analysis method, this paper focuses on system for payment of Skilled Nursing Facility under Part A of the Medicare program—Patient Driven Payment Model, and discusses the implementation plan of a long-term care insurance in Jingmen City from the perspectives of payment methods, payment grouping and payment standards. Results: Currently Jingmen adopts per-diem payment for long-term care insurance, so it is necessary to establish a payment based on population characteristics and demands. So, the patients should be classified into a group for each of the five case-mix adjusted components: physical therapy, occupational therapy, speech therapy, nursing and non-therapy ancillary. In addition, this payment model also includes a "variable per diem adjustment" to account for the changes in patient costs more accurately. Conclusions: The theoretical system of a long-term care insurance payment method is developed, and a localization plan for case-mixed-adjusted prospective payment system for long-term care insurance is provided. Therefore, Jingmen long-term care insurance payment should adopt "case-mixed adjustment", strengthening the relationship between individual clinical characteristics and payment.