The Oretical And Empirlcal Study On Control Of Hospitalization Expense

BackgroundAs the development of the basic health insurance and socioeconomic, the Medicare patients are increasing and incur the excessive increase in medical costs. However, the medical insurance system is facing many difficulties such as aging and disease spectrum. All those make it possible that medical costs will continue to rise in the future.The paying mode becomes a hot issue for health reform and should be carried out to control the unreasonable rising of expenditure. As the connection between the reform of medical institutions and pharmaceutical, the rationality of the paying mode plays an important role which can directly affect the whole medical insurance.During the period of11th Five-Year Plan, the system of medical insurance starts to be innovated and has obtained remarkable achievements. As a tool of resource allocation, it will keep developing and deal with a wide cross-section of society. In the next period, the medical insurance will expand the areas and mining the service potential which aims to conflict resolution and promote the social security system.Objectives1. To acquire the background information of the foundation and development history of basic health insurance in our country. And then to summarize the model cases of paying reform and expense control related to the medical insurance which aims to understand the relationship between paying mode and expense control.2. To make systematic summarizing of medical insurance in paying through literature review which to found out the major trend and useful proposals for the basic health insurance system of china.3. To take the example of cholecystectomy in order to analysis the quantity and performance of charges. On the basis of that, a control mode of payment will be carried out and a set of advice will be offered.Data and Methods 1. dataThe qualitative data mainly comes from CNKI、EBOSCO、 PUBMED et al which takes the key word of medical insurance for urban workers or new rural co-operative medical system. Moreover, the website of ministry of finance or health should be viewed to collect the information of statistic bulletin. And the commercial insurance institutions also should be caused concerned about the insurance actuarial.The quantitative data mainly comes from the medical records which root in four big hospitals of Xinjiang and Shandong provinces. The medical record contains the basic information of the patients, the diagnosis, costs and so on.2. Methods(1) Literature revi ewMost information uses the qualitative study to be analyzed in terms of content to find out the macro and micro changes such as the historical origin, institutional theory, cost composition and change trend.(2) Statistic methodWith the application of single factor and multi factors analysis, the surgery cost, factors and economic evaluation are investigated which in favor of allocation of health insurance resources.Results1. The expenditure between Xinjiang province and Jinan has great difference in two kinds of cholecystectomy. One-way analysis results show:age, sex, nation and operation model et al are the main factors of the cost.2. The cost in Urumqi and Jinan both rise from2008and the major source of the growth comes from the western medicine, diagnosis and others.3. The cost of Chinese medicine covers a large proportion in the city of Urumqi which is more than1000RMB.4. The cost of laparoscopic surgery for cholecyst is less than that of abdomen surgey which mainly due to less use of western medicine.5. The low fee of technology including the opretion cost and care cost which covers less than20%of the total expenditure. and the absolute value keeps declining.Conclusions and RecommendationsInfluencing factors for expenditure are multidimensional which related to the disease itself but also the social factors. As it shows from the research, the cost of western medicine, diagnosis and others play the leading role in cost increasing, so the basic health insurance should adjust the direction of compensation. What’s more, comprehensive reform should be implemented especially for promoting the clinical path and increasing the price of technical medical service which to change the unreasonable formation mechanism of price.