The Analysis Of Immediate Settlement Work And Hospitalization Expenses Of Out-of-town Medical Insured Members In One Of Top-three Hospitals In Shandong Province

Background:Out-of-town medical treatment behavior is based on the population flow,resource misallocation of health,the fragmentation of health care and the patients’demand for high quality medical resources.Out-of-town medical patients experienced from the initial advance policy to the current immediate settlement policy.30 provinces of China have achieved immediate settlement work in range of province in 2016.That Brings convenient but at the same time,the lack of effective management which may be excessive medical treatment among out-of-town patients.That will cause unreasonable and inefficient use of medical insurance fund.Objective:This study on the current status of the provincial out-of-town medical treatment is mainly to compare the difference of expenses between local patients and out-of-town Immediate settlement patients and analyze the influence factors of expense.Based on the analysis of the status quo of the out-of-town patients,the author puts forward the measures to standardize the management of out-of-town medical treatment.At the same time,the management experience of management provincial out-of-town medical treatment will bring reference to cross-provincial medical management.Methods:Object of this study is a influential top-three hospital in Shandong Province.The qualitative methods of this study mainly include literature research method and key informant interview,which can be used to understand the status of medical treatment in different countries and the basic situation of the target hospital.The quantitative analysis methods of the study are mainly descriptive analysis,single factor analysis and factor analysis.Analyze of the year-round number and the average cost of patients in the whole hospital from 2012 to 2016.Choose thyroid malignant tumor,gall bladder stones with chronic cholecystitis,uterine fibroids,three patients in 2016 including urban employees and out-of-town medical patients to compare hospital cost.Regression analysis was performed on patients with uterine leiomyoma.Results:On the whole,the number of out-of-town immediate settlement patients and the proportion of the whole hospitalized patients show a rising trend,which proves that the implementation effect of the policy is optimistic.The selected three kinds of disease show overall cost of out-of-town patients is significantly higher than local urban employee patients.Likewise,the expense of medicine and medical consumables.The composition expenses are not reasonable and the ratio of consumables is high.Discussion and Recommendation:According to the result of this study,the following suggestions are put forward:Rational allocation of regional medical service resources;Coordinate regional cooperation to standardize the treatment of patients in different places;Establishment of the coordination mechanism for out-of-town medical treatment;Formulating and detailing the content of the out-of-town medical treatment protocol;making full use of primary medical resources to relieve the burden of medical care.