| 1. Study Objectives and SignificancesThe health care sector is a major livelihood issue, as it is closely related to the health of billions of people and the happiness of every household. Since the founding of the People's Republic of China in 1949, and since the beginning of the reform and opening-up in particular, China's health care sector has made remarkable achievements. At the same time, we must be aware that there is still a rather prominent contradiction between the current development level of China's health care sector and the people's health demands and the requirements of balanced socio-economic development. When it comes to medical care services and process, however, the demander (the community), the supplier (hospital and medical staff) and the organizer (the government) of medical care services are all unsatisfied. Although what the demander, the supplier and the organizer complained about was not the same object, the key problem what three of them extremely concerned was just over-Increasing medical care expenditure. The study stressed that over-increasing medical care expenditure was still the focus problem in the field of medical services. So, to address the problem of over-increasing medical care expenditure has been an important goal of the Health Care System Reform. As to the scientific policy-making procedure, to sever a problem need to clear its root causes and mechanisms firstly. Therefore, based on that the total project had clear the mechanism of over-increasing medical care expenditure qualitatively, the study was to quantitatively research the mechanism of over-Increasing medical care expenditure in the year from 1991 to 2008, and then compared similarities and differences of the mechanism between before and after 1998. For the purpose of establishing a health care system with Chinese characteristics, of gradually realizing the goal that everyone is entitled to basic health care services, and of raising the health level of the Chinese people, we hereby put forward the following opinions on proving the cause and mechanism of over-increasing medical care expenditure, and on deepening the health care system reform.2. Research methods and Data SourcesThe scientific policy-making procedure was selected as the principle method, and selected the qualitative and quantitative mechanism models of over-increasing medical care expenditure as the applied research methods. The framework and thinking of the quantitative study of the mechanism of over-increasing medical care expenditure in China formatted on the basis of preliminary research of the total project. The data used in the study was collected mainly from statistics including China Statistical Yearbook, China Population Statistics Yearbook and health accounts funding information of the year from 1991 to 2008.Then we collated those data collected from these statistics to be a database which could be analyzed directly. By put China's medical expenses of the year from 1991 to 2008 into the corresponding part of the calculation formula, we could quantitatively proof the mechanism of over-increasing medical care expenditure in China every year, and could quantitatively analyze the changes of the mechanism of over-increasing medical care expenditure year by year.3. Main study results3.1The current vicious circle of medical institutions still exist, a waste of medical resources is more serious than it was 10 years agoThis study demonstrated further evidence to the team's pre-discovery that China's public hospitals'compensation mechanism wasted a lot of social resources, showing a vicious circle phenomenon, which was more serious than 10 years ago. Lack of financial investment had let to over-increasing medical care expenditure, more serious social burdens and the waste of medical resources. Of course, the vicious compensation mechanism also reveals that if the hospital compensation mechanism does not break the vicious cycle, if the causes and the trigger factors are not resolved, there is no way to go to control the excessive growth of medical expenses and to resolve the heavy burden of medical costs. Many of health reform policies had been formulated, but these serious problems still exists that these health reform policies has no much effect.3.2 financial and material prices remain the responsibility of over-increasing medical care expenditureThis study clearly demonstrated finance, price and hospitals respective responsibilities that financial and material prices remain the responsibility of over-increasing medical care expenditure. The study stated the key causes of over-increase of medical care expenditure are the continual atrophy of government input and unreasonable fee schedule of medical care services. The study also suggests that the function mechanism of over-increasing medical care expenditure is a dynamic process of social interaction between the continual atrophy of government input and unreasonable fee schedule of medical care services and hospitals follows this progress to pursue the maximum of its benefits. But compared with the stage from 1991 to 1998, hospitals did not get enough interests in the stage from 1999 to 2008. If the current inadequate financial compensation situation was not resolved, hospitals will face a more difficult situation. By analysis of per medical expenditure and medical need, the study found that there were many irrational behaviors when hospitals provided services for patients. Even though the hospital irrational behavior can be interpreted as the passive adaptation behavior to the continual atrophy of government input and unreasonable fee schedule of medical care services, the damage what hospitals did to demanders cannot be ignored, especially in the combined effect of increasing cost and rising demand, leading to more serious damage to demanders.3.3 The over-increasing medical care expenditure is still more than the capacity of patients at this stageIn the past 18 years (from 1991 to 2008), the actual growth rate of medical costs (18.4-27.9%) is more than reasonable growth rate (18.3-26.2%), although growth is not excessive, but only 37.2-58.2% of the actual growth rate of medical costs can get a reasonable explanation, while 41.8-62.8% of the medical costs cannot be reasonably explained. Volume increased slightly, but unreasonable explanation is more than 40%, meaning that unfair distribution of health resources, medical expenses will further increase the burden of the patients at their own expense. This will inevitably affect the demand, especially for private patients in the relative demand atrophy (7.7-10.4%), thereby affect the absolute demand (-1.2-3.4%). Considering both above, the actual shrinkage is up to 8.1-13.6%, national medical demand for services shrink markedly. If hospital waste compensation mechanism is not eliminated, hospital depending on medical expenses will not be changed, the excessive growth of medical costs trend seen again.3.4 Attribution analysis showed that per medical expenditure still play major roles in over-increasing medical care expenditureComprehensive analysis of the national situation, whether total, inpatient or outpatient, per medical expenditure played a major role in the over-increasing medical care expenditure, while the number of visits played a secondary role, which suggesting that the excessive growth of medical expenses is mainly because hospitals passed economic difficulties due to insufficient financial investment on to patients. The over-increasing medical care expenditure increased the social burden and the waste of resources. Analysis phases, it is prompted the role of hospital through providing medical services to increase hospital revenue is growing slowly with the building of medical insurance system and the construction of basic medical health. Of course, it is also possible because of the decomposition of medical services.3.5 Medical reform policy has been developed one after another in 18 years, but the mechanism of over-increasing medical care expenditure has no significant changeIn the last two decades, many of health care reform measures taken trying to solve the problem of over-increasing medical care expenditure, but, through quantitative research, the study demonstrated that there was no significant change in the key factors, the root causes and the mechanism of over-increasing medical care expenditure in the years after 1998 compared to the years before 1998.When Medicare has not been effective in cost-sharing commitment, the excessive growth of medical care expenditure is still the main reason which leads to the problem of "expensive medical" and other major issues. The root causes of over-increasing medical care expenditure are the continual atrophy of government input and the unreasonable hospital payment, while precipitating factor is unreasonable fee schedule of medical care services. The function mechanism of over-increasing medical care expenditure can be expressed through a dynamic process of social interaction. The social interaction occurs among government financial and price bureaus, health system or hospitals, government and labor insurance systems and their insurers, industries related to medical services, etc. In this process, all these groups show the characteristics to pursue or maintain the maximum of their own benefits. The other social issues related to health sector are caused by same factors and can be expressed by same mechanism. These issues include the disorder of drug market, falling-low morals of medical services, unreasonable managerial orientation, declining quality and attitude of medical care, resources waste and unbalance between so-called social and financial benefits, etc, and eventually these cause medical care expenditure growing too fast.4. Innovation and applicationAfter proposed more than ten years, the theory of the mechanism of over-increasing medical care expenditure had been accepted widely and many people had discussed the theory at different levels in different study. However, since the discussion group quantitative researched the mechanism of over-increasing medical care expenditure in 1998, this mechanism has been lack of systematic quantitative for many years. Combination of China's national conditions, this study systematically collected and organized the data of China's hospital for twenty years, analyzed and compared the changes of the mechanism of over-increasing medical care expenditure in the year of 1991 to 2008, and then compared similarities and differences of the mechanism between before and after 1998, finally cleared the mechanism of over-increasing medical care expenditure after 1998, and also quantitatively demonstrates the rationality of the model once again. There did not find any conflict between quantitative conclusions this study came to and qualitative conclusions which had been proved before, which means the mechanism of over-increasing medical care expenditure of scientific rationality. Therefore, there are enough reasons to believe that this study together with the qualitative argument conclusions can reveal the root causes and the mechanisms of key issues, also can explain the formation of other processes of other social problems associated with the key issues. This study had cleared that how much the social consequences caused by insufficient financial investment was under the vicious circle of medical institution, so as to develop policy ideas for the causes and mechanisms of key issues... |
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