Research On The Control Of Medical Insurance Expendirue In China

Broadly speaking, medical insurance expenses means the total sum of medical expenses after the insured person's illness .The control of medical insurance expenses is an essential tool for the management of medical insurance expenditure. The controlled object is the various types of medical expenses in the scope of medical insurance. The purpose is to achieve the principle of maintaining the basic medical care and safeguarding the fundamental rights of the insured people to the largest extend.The control of medical insurance expenses is a universal problem and its essentiality is self-evident. The establishment of a controlling mechanism of medical insurance cost aims at maintaining the basic operation and sustainable development of itself, ensuring the balance of payments of the fund, handling the relationship among the doctors, patients and insurers, safeguarding the rights and interests of the insured , establishing a harmonious society, promoting the "three simultaneous reform" and truly establishing an independent social medical insurance system which is out of the control of enterprises and institutions.The control of medical insurance expenses has become an important issue in the worldwide range, especially for China. Therefore, it is of significant theoretical value and important realistic pertinence to develop the research of medical insurance expenses control, establish a medical insurance expenses controlling system so as to control the medical insurance expenditure effectively and to make sure the vast majority of residents can receive medical insurance to the maximum scale.This paper expresses and analyzes the reverent theories of medical insurance expenses control, such as disease risk theory, the supply and demand theory, large numbers rule, game theory, health management and cybernetics.This paper uses the model of multiple linear regressions to establish the relationship among demander, supplier and medical insurance expenses, making clear the main factors that affect the increase of medical insurance expenses. Meanwhile, the author predicts the trend of expenses in the following five years by using the time series method.The research shows that China' s medical insurance expenses showed a go-up tendency in the past ten years. There is a positive correlation among the medical insurance expenses, the average income of per hospital, the proportion of government expenditure on health, and the per-capita health expenses. There is a negative correlation among the medical insurance expenses, the number of the health technological personnel, and the total price-index of citizen consumption. The difficulties lies in the natural monopoly and the price rigid, the induced medical demand and virtue risks caused by information asymmetry existing in the fields of medical service and medical insurance.There are various tools used for medical insurance expenses control in the world. They can be divided into three categories: macroscopic control and the control of the demanders and the suppliers in the medical insurance. The tendency of medical insurance expenses controlling mechanism is transferring from emphasizing the control of demanders to the control of suppliers, from the control of quantity to the control of structure, from the control of restriction to the control of inductivity, from the relationship of take and receive control to the collaborative development of mutual control, from the triple coordinated relationship of the insured, the assured and the medical service suppliers to bilateral relationship of the medical insurance organization and the service suppliers and demanders. This paper also researches the experience of typical countries in their medical insurance expenses control which we can learn from.From 1980s, the means of medical insurance payment had undergone tremendous changes. This article shows the development trend and they can be summarized as below: the mean of payment changing from after-payment to prepayment, the standard of payment changing from free pricing to government control price or unified price, the mode of payment changing from paying in full to partially self-paid, the system of payment changing from dispersion and independent to centralized and unified. When choosing the means of medical insurance payment, we should consider the following three points: firstly, choosing the different payment models for different supply organizations; secondly, using the mix payment means for specific suppliers; thirdly, taking the suitable methods in payment according to the different service supplied.This paper uses the game theory to analyses the motivation and decision of benefit distribution between the government and the medical insurance organization, between the medical insurance organization and the supplier of medical service, between the demander and the supplier, and between the medical insurance organization and the demander of medical service. It also uses the mixed game theory to do some research on the medical insurance expenses control.This paper introduces the example of Zhenjiang, one of the medical innovation of pilot cities, describing its exploration and practice in its medical insurance expenses in the last decade year. The method of its medical insurance expenses control has evolved from"Fee for Service Unit" to "Integrated Control". Through the comprehensive evaluation and analysis of the effect, we find that Zhenjiang's medical insurance expenses control model is the best one in China.This paper puts forward some basic principles and a series of control methods for the medical insurance expenses control in the end which includes the strengthening of the macro-control of medical insurance expenses, enhancing the control of the four aspects of medical insurance, accelerating the reform of expenses payment means, promoting the control of moral hazards in medical insurance, intensifying the control of medical insurance expenses by using health management.