The Research On Constraint Mechanism Of Medical Insurance Expenditure Control

At present, medical insurance expenditure is rising in China and other countries. It is institutional factors that promote irrational rising medical insurance expenditure fundamentally, which is different from other countries. As a third party payment mechanisms, medical insurance system can check and balance both supply side and demand side endogenously. But because our medical insurance system is exploring, the checks and balances mechanism has not been deeply researched. Although some control measures have been made in practice, the effect is limited and the mechanism is not systematic.Therefore, the object of research is that how to control unreasonable rising costs of medical insurance. Based on the analysis of endogenous checks and balances mechanism of medical insurance, the thesis tried to build medical insurance system of checks and balances to achieve effective control of costs.Based on the collation and analysis of related literature, the thesis reviews, summarizes and evaluates current medical insurance expenditure control policies in China; Then, the systems research in a macro perspective and the empirical research in a micro perspective are applied to analyze the factors of medical insurance expenditure rising. On the one hand, the goals, relationship, game strategies and causality of behavior of stakeholders in medical insurance system are explored, which reveals the fundamental cause of unreasonable rising of medical insurance expenditure; On the other hand, based on the data from the medical insurance database of Tianjin medical insurance settlement center in 2008, a path model was made to analyze the direct factors of medical insurance expenditure; Finally, on the basis of reexamine and clear the objectives of medical insurance expenditure control, the thesis builds up comprehensive checks and balances mechanism system, and some macro-support policy recommendations are provided.The main conclusions of this study are as follows: (1) there are many stakeholders who have theirselves interests involved in medical insurance system. The multi-stakeholder behaviors and their interaction lead to the rising medical insurance expenditure. In the game process, medical insurance organization checks and balances the interests and the behaviors of medical service providers and insured patients. It is institutional factors that led to unreasonable rising of medical insurance expenditure; (2) the direct factors of medical insurance expenditure are revealed by path analysis which clearly describes complex relationship hierarchy of variables. The research found that the main factors include length of hospital stay, the proportion of personal burden, hospital types, disease, drug costs and other clinical features. Some variables affect medical insurance expenditure not only directly but also indirectly through the length of hospital stay; (3) the thesis builds up comprehensive checks and balances mechanism system to balance various interests and control medical insurance expenditure, which includes pre-negotiation mechanism mid-clearing mechanism, post- assessments mechanism, and information disclosure and supervision mechanisms in the whole process.