Nursing performance management under the reform of health insurance payment in China

Abstract

Introduction: In recent years, China's medical insurance payment reform has shifted from “project-based payment” to composite payment modes such as Diagnosis-Related-Group/Big Data Diagnosis-Intervention Pocket (DRG/DIP) payment and total prepayment, aiming to control medical costs and improve service efficiency. Nursing, as the core process of health services, its performance management directly affects the quality of nursing and the effectiveness of medical insurance fund utilization. At present, the reform of medical insurance payment modes has posed new requirements for nursing staffing, service processes, cost control, etc. However, the problems of single evaluation indicators and insufficient connection with medical insurance policies in traditional nursing performance management urgently need to be solved.

Methods: This review analyzed the correlation between medical insurance payment reform and nursing performance management and sorted out the current practice status, challenges, and optimization paths of nursing performance system under the background of existing policies.

Results: In response to the impact brought about by the new healthcare payment reform, it is necessary to establish a healthcare-nursing linkage indicator system, formulate detailed nursing cost accounting and budget management, and innovate the performance distribution mechanism.

Conclusions: The article provides reference for building a nursing performance management model that conforms to the orientation of health insurance reform.