Study On Current Situation And Countermeasure In Settlement Of Medicine Insurance For The Unit Of Jilin Province

It is one of important responsibility for government to construct right medical security system which is realistic action directly linking to the pressing benefit of people and will bring far-reaching effect on our country and offspring. With policies of , , promulgated, the politic framework for establishing multi-levels medical security system in China is coming into being, and several aims are put forwarded: ensuring new-type rural cooperative medical policy carried out through country and enhancing the level of fund raising and the ratio of wiping out increasingly up to the end of 2008, implementing the basic medicine insurance harboring all of employee in town and bringing basic medicine insurance for townspeople into effect roundly, realizing the aim of constructing medical security system covering all people. The medical security system in our country classify security levels by different personnel into employee in town, non-employee in town and peasants, but all of them will enjoy the medicine security from the basic model-insurance. So, medicine insurance, as key of the system, is focus of the society's concern.As for the world-wide problem of putting medicine insurance into practice, the key of it is the special four relation among medicine, insurance, sufferer and government and payment of the third party, especially, the medicine management and the cost containment are the difficulties of the problem, so, the way of cost settlement is the key to realize management and containment. It is necessary to make scientific, reasonable, convenient and facile way of medicine insurance cost settlement for ensuring exact payment of medicine insurance cost, controlling unreasonable expenditure of medicine, regulating and guiding the action of medicine service department, insuring the insured getting medical treatment, making both ends meet in medicine insurance fund. In addition, making reasonable way of medicine cost payment is a powerful guarantee for the well sustaining development of medical sanitation institutionIn this article, we combine ways of theory and practice, common and specialty, home and abroad, actuality and development, quantitative and qualitative analysis, applying the analysis of economics, Insurance, statistics and determining the nature and so on to study the way of medicine insurance cost for the unit of Jilin province, and put forward a compound prepay settlement way so much so that we can provide powerful theoretic supporting and methodological guarantee for the practice of medicine insurance management in whole province.At first, this article systematically analyzed the main settlement models of medicine insurance cost in abroad and found out some rules in it, compared it with the implement situation of medicine insurance cost settlement in some regions, China; then, summed up the construction, framework, methods, working models of medicine insurance settlement system for the unit of Jilin province and the actual situation of cost settlement from 2003 to 2007, appraising the role of settlement way, the forming experience, and real question appearing during process of implement for settlement way; at last, based on above analysis, appraising and systematically summing up, this article use new idea to work out an applicable settlement way which could accord with the scale of local economic development and follow the law of cost settlement development in home and abroad to form a compound prepay settlement way which take gross budget counted by percent as the main part, cell ration, service quality controlling, item settlement and disease types settlement as assistant for medicine insurance pooling funds, bring forward a model which could be sorted and classified by factors of medical institution scale, service quantity and service ability, a settlement system framework regulated dynamically, a compound settlement system comprised by different settlement models.At present, the settlement way has been carried out in the medicine insurance cost settlement in the unit of Jilin Province. We hope that the benefit of the insured could be well guaranteed through implement and improvement of the way and promote the construction of medicine security system.