The Impact On Medical Expense Of Credit Rank Assessment Of Medical Insurance Contracted Hospitals

BackgroundThe measures of medical expenses controll which all cities in china taking in medical insurance at present have not gotten_expected objective. In light of the theory of health economics and the practice of international medical insurance reform, making effective regulation on producer's behavior is the main component of medical insurance management. But as the low propotion of people covered by medical insurance and dissymytry of information between consumers and medical service providers, and monopoly of providers in some areas, in the process of gaming between medical insurance bureaus and hospitals, hospitals and doctors are on a good wicket, the managing organizations bureaus cannot effectively restrict providers'behavior. Owing to the lack of effective restricting providers' behavior, Shandong Provincial Social Insurance Bureau put forward a new measure that is credit rank assessment among medical insurance contracted hospitals. Begin from 2004, Shandong Provincial Social Insurance Bureau have arranged two cities, Dong-ying and Lin-yi, as experimental units.The basic thought of caning credit rank assessment system of medical insurance contracted hospitals is through ascertaining hospital's credit rank to influence their reputation. Their credit rank will be publicly exposed by official credit board and media. Thus,the system not only affect in-patient flow in medical insurance,but also in-patient flow having no medical insurance.The measure will affect hospital's income and social reputation,alter the inferior position of medical insurance organization gaming with hospitals, strengthen restraint to contracted hospitals,then restrict medical behavior effectively and control the rise of medical expenses. Furthermore,affected by existing model of our country,the system can cause two negative impacts: the first is hospitals will implement cost-shifting to non-medical insurance patients for the sake of making up loss on medical insurance patients; the second is hospitals shift some hospitalization expenses on to outpatient expenses since medical insurance organizations centrally manage hospitalization expenses and don't manage outpatient individual account expenses.Study objectives and investigation contentsThis research is to examine logical relationship among multiple relevant facors, using statistical methods and computation tool analyze the final effect of this management measure systematically and deeply. So that, scientific and excat conclusions, will be obtained. Then put forward corresponding recommendations. The aim of this research is to provide scientific foundation to medical insurance system and improve efficiency.MethodologyIn the light of the five hospitals' service quantity from 2000 to 2004, we forcasted service quantity in 2005 of every hospital investigated, compared the predicted quantity and real quantity to ascertain different influence of different credit rank, then analyzed service income of every hospital. The research analyzed hospital staff's cognition to essentiality of different credit rank hospital's reputation, using gross probability deduction and chi-square test, etc. The thesis also analyzed total medical expenses and expenses payed by individuals with five diseases among three credit rank hospitals. Then, the paper compared all kinds of factors between patients having medical insurance and having no medical insurance. Finally, the paper analyzed rate of increase of average outpatient expenses of patient having medical insurance from 2000 to 2005, and analyzed the different rate of increase of average outpatient expenses between two kinds of patient in the same period.Main Conclusion1. Implementation of the medical insurance contracted hospital's credit rank system affected income and social reputation of hospitals obviously.The analysis toward service quantity of hospitals indicated that credit rank system had obvious influence for economy income of medical insurance contracted hospitals. The analysis toward cognition about social reputation of hospitals' clerks and inhabitants indicated that the lower credit rank hospitals had stronger inclination to improve their credit rank, or the higher credit rank hospitals inclined to keep their former rank; Cognitions of inhabitants toward prestige of hospitals keep identical with the credit rank of hospitals. We thought that the credit rank system were of obvious impact toward different credit rank hospitals between income and social reputation.2. The system strengthened management capability of medical insurance organizations.The analysis results of income and social reputation indicated that the system improved restriction ability of medical insurance manage organization toward hospitals and manage organization kept advantageous status in process of gaming with hospitals, manage ability and force of manage organization strengthened obviously.3. The system had different expense control effect about different credit rank hospital.The system were of strongest effects toward A credit rank hospitals in expenses control, expenses appeared steadiness and declination. The system decreased expenses growth rate of absolute majority diseases in B credit rank hospitals. The expenses growth rate of C credit rank hospitals kept unchanged whether credit rank assessing or publicizing the credit rank assessment results, so the effects of expenses control toward C credit rank hospitals were worst.4. The system reduced individual burden of medical expenses in all kinds of hospitals at different degree.The individual burden of majority diseases in A credit rank hospitals emerged downtrend in two years of system implement; the individual burden in B credit rank hospitals had no obvious change in the year of credit rank assessing; but it began to reduce after the assessment results were publicized; individual burden in C credit rank hospitals kept unchanged in the year of credit rank assessing, but publicity of assessment results impacted individual burden of some diseases. So, it shown that the system reduced individual burden among all hospitals, and the influencing force was directly proportional to credit rank of hospitals.5. The higher credit rank hospitals shifted medical eipenses from patients having medical insurance to patients having no medical insurance early or late.The system impacted expenses structure of A and B credit rank hospitals obviously, cost-shifting of A credit rank hospitals emerged in first year, cost-shifting of B credit rank hospitals emerged in the second year, and C credit rank hospitals did not take place cost-shifting.6. The hospitals with higher credit rank shifted outpatient expenses to inpatient expenses.A credit rank hospitals shifted inpatient expenses to outpatient expenses in both years of implementing the system; outpatient cost-shifting of B credit rank hospitals appeared in 2005; the outpatient cost-shifting did not appear in C credit rank hospitals in both 2004 and 2005.7. The higher credit rank hospital always makes up loss caused by credit ranking assessment by means of cost-shifting.In the light of analysis, there was a synchronism between expense control and cost-shifting in three credit rank hospitals. Based on that, we thought that A and B credit rank hospitals obtained higher credit rank from abiding by the credit rank system, but the higher credit rank hospitals make up loss caused by credit ranking assessment by means of cost-shifting.Policy AdviceAccording to systematic analysis of investigated data, this paper put forward policy advices as follows:1. The system should be carried out entirely. Shandong procince medical insurance credit rank system achieved expected aim basicly in expense control.Inpatient expenses of the major portion hospitals were controlled effectively after implementation of the system, and managing ability and force of manage organization strengthened obviously, individual burden of medical insurance patients alleviated. So the system should be popularized to other cities step by step.2. Ajust and improve criteria for assessment of the system.The system and assessing criterion had several faultiness, it should be adjusted and revised according to reality.3. Study the system prolonged and systemically.Some contents of the system took obvious effects in studied two years,but other contents could obtain more consummate conclusion only by studing for a longer time. 4. Study and work up systematic measure to control inpatient expense-shifting.To control inpatient cost-shifting effectively,steps as follows is essential: firstly,enlarge coverage of medical insurance system,have more and more people protected by medical insurance system,till medical insurance system cover all people;secondly,increase investment of government to hospitals to eliminate hospitals' motivity of seeking economy benefit gradually;finnaly,for the sake of banishing inpatient cost-shifting, it is necessary to assess hospitals'credit rank performed by health bureau and medical insurance organization jointly.5. Strengthen management of medical insurance individual accounts.Strengthen supervisal to medical insurance individual accounts by measures as follows: firstly, for walling up the routeway of shifting inpatient expenses to outpatient expenses, increasing index related to outpatient expenses control in assessment criterions is necessary; secondly, establishing mechanism accertaining value of medical insurance individual accounts stable or rising with medical expenses inflation, make employee joining in medical insurance establish effective accumulating inclination; at last, moniter use of drugs and diagnosising/treating items in outpatient recipe and punish behaviors supassing criterions.