The Impact of China's Total Medical Insurance Package Payment Based on Compact County Medical Community and Its Implications for Medical Insurance Funds: Evidence from Y County, China

Abstract Background: Due to the irrational structure of medical and health resources, uneven distribution, and low level of grassroots services, traditional medical insurance payment methods in China’s underdeveloped areas have not been fully utilized in regulating medical service behaviors and guiding the allocation of medical resources. The medical insurance fund of many regions collapsed, the fund balance rate and compensation rate decreased year by year, and the medical expenses rose rapidly, which seriously affected the enthusiasm of the insured residents. As a results,the sustainable development of the medical insurance fund faced many difficulties and challenges.Based on this, we want to design a medical insurance policy suitable for underdeveloped areas in China to improve the capacity and efficiency of health services and maintain the stability of medical insurance funds. Methods :Collected medical insurance data of Y County in China from 2018 to 2019.The interruption time series(ITS) was used to evaluate the utilization of medical insurance funds in county-level hospitals, primary health service centers, and hospitals outside the medical community. Results: Inpatient expenditure(IE) per capita,out-of-pocket inpatient expenditure(OIE) per capita,and medical insurance expenditure (MIE)per capita in county-level hospitals increased by 84.682, 6.564 and 62.302 yuan per month respectively after the reform; Number of annul discharges persons(NOADP)from basic health service centers increased by 36.899 per month after the reform; IE per capita and MIE per capita increased by 18.624 yuan and 15.767 yuan per month on average after the reform; the residents hospitalized outside CCMC decreased by 9.545 per month on average after the reform. Conclusions: China should further implement the CCMC-based TMIPPM reform to control medical expenses and maintain the stability of medical insurance funds in in more trials.