Effect Analysis Of Medical Expenses Management For Oilfield Patients Who Took Medical Care

The matter of health security is a difficult problem that all governments in the world had to face. This problem became more and more prominent and important with rapidly increased expense of health insurance and global economic crisis. Most studies about health insurance were localized in health systems and policies in our country. Managing medical cost that patients spent in different sections of hospitalization and management efficiency were seldom reported.This study analyzed the current situations, problems and reasons of health insurance management to patients who took health care in Daqing oilfield general hospital. There were some suggestions for how to settle problems from the study. The patients'treatment was settled well and loss of health insurance funds was prevented by control medical cost of these patients. Economic and society profits of funds utilization were enhanced.Patients who took health care can use their health insurance cards in the certified hospitals. They paid nothing whenever they need medicine, check-up or lab in the hospitals. All the cost were recorded by the certified hospitals and paid by health care centers.Because of lack of validity management and restriction methods, these patients'medical cost increased rapidly. Waste phenomena were severe. Medical costs of clinics were 183.84 times more than that of common employees covered by the insurance program. The rate of clinical cost of common employees covered by the insurance program was 0.64 percent more in 2007 than in 2006 .It was 42.64 percent more for patients who took health care at the same time. Compared with steady clinical cost of common employees, it was an abnormal increase.There were three main problems in medical cost management. The first was certified hospitals and health insurance institutions. The second was patients themselves who took health care. The third was medical staffs.A series of rules and regulations for patients who took health care in certified general oilfield hospital had been carried out at the beginning of 2008.Survey and evaluation to specified departments should be carried out by the hospitals. Health service was standardized. Special management methods were provided for clinical expense and hospitalization expense as well as refunded expense that was referred to other hospitals. All of these should be severely controlled.Management carried out from these sides as followed. They were the clinical and hospitalization work process, clinical and hospitalization expense, patients'going out, transferring consultation, special peoples'supervising who were pointed by health insurance departments, severe controlled management, fieldwork and doctors'shifting work periodically.The effect was obvious with one year of management. The high medical expense of patients who took health care was effectively controlled. Rapidly increased clinical expenses were kept down. Compared the clinical expense with whole expense throughout the years, clinical expense took 70 percent of whole expense.The results as followed could be concluded by accounting expense that new methods be taken. Management methods that controlled medical expense were possible. Average patient medical expense decreased 44.65 percent, over anticipated goal of 10 to 30 percent, which showed valid of management. Average patient clinical expense decreased 47.33 percent, over anticipated goal of 20 to 30 percent. More emphasis should be paid to management of clinical expense.The medical cost management of patients who took health care reflected a common problem in health insurance reform .With the proceeding of reform of health insurance and medical as well as drug distribution system work in coordination of hospitals and patients'health insurance, the management of health insurance to these patients is developing gradually well.