The Study On Medical Insurance Expenses Restriction Mechanism Of China

Medical insurance system reform of China is important component of the establishing and perfection of social security system in recent years, and the expenses controlling is the key of medical insurance system. Setting up effective expenses restriction mechanism and effective risks allocation mechanism, is not only the key of the social medical insurance system reform, but a problem that the commercial health insurance must be solved.The research and exploration about the reform scheme of social medical insurance system have a history of more than ten years. Since health insurance became a hot topic, various articles have researched problems about it, such as its market space, risk management, development prospects management tactics etc. But seldom touches the core of problems: the particularity of health insurance: medical care provider is the key of medical expense control. If relations between insurance company and care provider couldn't be built up successfully, the fast development of health insurance is impossible. Therefore this essay will discuss cost control from the point of medical care provider and solve the problem. The paper focuses on medical insurance expenses restriction, on the basis of analyzing the system of medical insurance and health care system, point out the main reason of the unreasonable increasing of the medical expenses and has carried on the discussion to medical insurance expenses restriction mechanism from the macroscopic and micro aspect separately.The paper emphasize that the close relation between medical insurance system and health care system is institutional reason of the unreasonable increasing of medical expenses. It is because that the risk of the imperfect health care system will be shifted to medical insurance system. Therefore, the medical insurance expenses controlling should be set about from the reforming of health care system.The paper clarifies the moral risk questions of consumers and suppliers in details.It puts forward several methods to restrain medical expenses from two points of consumers and suppliers respectively; this is the key of medical insurance expenses restriction mechanism. The means to reduce moral risk of consumers includes supervision and incentive, while the supplier controlling includes establishing market supervision mechanism and doctor's prestige assessing mechanism, adopting scientific way of paying, the integration of medical insurance and medical institution.The paper carries on detailed discussion of the integration of medical insurance and medical institution. Through comparing the operational mode of the traditional medical insurance with the mode under the integration, we can draw the conclusion: The best way to control medical expenses is integration of medical insurance and medical institution.