| In December 14,1998,the state council promulgated a degree: decision about setting up fundamental Medical Insurance System for Staff and Workers of Cities and towns. This degree marked that new social security system would take place of old free medical service and labor protection medical security system that had been carried out for more than forty years. The most remarkable difference between new and old substantial content system is "low level, wide range". This reformation focuses on staff and workers of cities and towns, the most population in rural area as well as the self-employed have not been included. Therefore the commercial health insurance is given great opportunity. The unsecured have to seek insurance from commercial insurance companies. Meanwhile, various factors including income increases, the strength of health realization, the application of high -grade technology and currency inflation etc. lead to rise medical expense, the reform of medical security system and the rising of medical expense make health insurance a hot topic. But the commercial heath insurance did not develop as fast as expected, the reason lies in the particularity of health insurance: medical care provider is the key of medical expense control. Therefore this essay will discuss cost control from the point of medical care provider and solve the problem. The reformation of social medical security system is one of the five prime tasks of economic and political structures innovation. The research and exploration about the reform scheme have a history of more ten years. Since health insurance became a hot topic, various articles have researched problems about it, such as its market space, risk management, development prospects management tactics etc. But seldom touches the core of problems: the medical care provider. If relations between insurance company and care provider couldn't be built up successfully, the fastdevelopment of health insurance is impossible.This thesis is based on the theory of three parties' relations in health insurance. First, it neatly introduces the cost control from the point of demand side; then from the care supply side, which is the emphasis of the whole thesis and focuses on the payment methods of medical expense. Secondly, it explains American Managed Care and its means of cost control of medical expense. Finally, it puts forward proposals to health insurance development in China. The essay consists of about thirty thousand words and four chapters.Chapter 1 is to provide the basis concepts and relevant problems of health insurance system. At first, the thesis gives a definition of health insurance and discusses the relationship of social medical insurance and commercial health insurance. Then it analyses the characteristics of medical service and supply and the relationship between patients and supplier. At last, it explains the structure of the health insurance system and the peculiar tripartite relationship among the patient, the doctor and insurer. The occurrence of health insurance changed the traditional bilateral trade parties into the tripartite parties of medical care supplier-health insurer-patient. The patient gives rise to the payment of medical expense, but lands in a passive position and lacks the conscious of thrifty because of asymmetric information, demand inflexibility and preference of service abuse. The medical-care provider takes on two contradictory characters: from one side, he decides the quantity and kinds of medical care; from the other side, he is paid for his services. This contradiction makes him negative in cost control. The insurer pays to care provider on behalf of patients, but lacks the information of care cost, indemnity expense and relevant technical standard; so as to let the key party-medical care provider out of control.Therefore cost control primarily lies in the control of patients and care providers. Chapter 2 introduces the means of medical cost control,which is the core of the whole essay. It induces risk selection, the... |
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