The Study On The Vertical Integration Of Medical Insurance And Control Of Medical Expenses

Since the 70`s in twenties century, the rapid increase in the medical expenses andcontrol of such expenses have become the common problem, this make the medical services and medical insurance the focus of research. Though several years such research with the help of economics has formed the Health Economics System including medical economics analysis ,medical insurance analysis,medicine economics analysis,medical technology and education analysis and macro economic regulation analysis. The persistent increase in medical expenses in American and European make necessary the deeper research and discussion about medical expenses control. Such problems involved rapid increase in medical expenses, lag in medical insurance and shortage in medicare services have becomes more and more important in our country, the systematic economics analysis that treat medical expenses as the subject has still been short of research in recent years. Based on such facts, the dissertation treats medical expenses, medical insurance and medicare and their relations the main subject of research.The dissertation carries out its research in this way: firstly, the easy way to observe the increase in medical expenses is based on this assumption: medical expense=medical service×medical price. Under the condition of stability of medical price, the rapid increase in medical expenses comes from the increase in medical service such as total treatment person-time and residential days caused by broad boundary in medical insurance system, unreasonable consumption tendency, such facts show the distortion in medical insurance system; under the condition of relative stability in medical service, the increase medical expenses come from rapid increase in medical price and factors such as the unbalance in demand and supply, unreasonable increase in medical cost, the monopoly in medical service, that facts show that medical resources arrangement structure and efficiency has not reach the optimization. As a result, the dissertation makes the relevant research in these two aspects: how to maintain the medicare system; how to optimize the medical resources arrangement.Secondly, the insurance comes into the medical service market, changing the price relationship between medical service consumers and providers to create "the third party payment system". Under such system, how to deal with moral hazard and adverse selection becomes special important. How to control such negative effect brought to medical insurance departments becomes the principal challenge for various countries. So the system of "cost sharing" becomes the main policy instrument in medical insurance in different countries. However, the system of cost sharing by providers with the PPS as the representative can create economic incentive of providers to supply such services, but also bring too high transaction cost. Based on above- mentioned analysis, the dissertation apply transaction cost theory in system economics and principal-agent principle in information economics to such problem, advance and prove the vertical integration pattern in medical insurance and medical service. This pattern not only can reduce exogenous transaction cost and risk of the medical insurance, it also can form balanced system based on market competition to control the increase of the medical expenses.Thirdly, medicare system aims to insure the health of people which also expends the costs, one of the country can be too rich to satisfy the healthy need. Under the limited medical resources, the opposition and unity of justice and efficiency is still the main conflict in the medicare system. The practices of medicare throughout the world show that emphasis on the justice in the welfare medicare system inevitably results in low-efficient services and extravagant medical resources, but emphasis on the efficiency of the commercial medicare system result in increase in the uninsured people and decreased opportunities of medicare for social minority. It is not advisable to sacrifice the civil equality to enjoy t...