Outpatient Medical Insurance For Urban Residents Cost Control Research

ObjectiveAs urban residential medical insurance has been carried out and outpatientfinance scheme is commonly adopted, how to control its price turns out to be a focalquestion. This study not only brought a summary to medical insurance controlmeasures, the foreign outpatient fee control experience and domestic outpatientfinance scheme realization, but also analyzed outpatient finance scheme and solutionof severe disease of Jiangsu Nanjing urban residential medical insurance. Finally,some recommendations to control outpatient fees of urban residential medicalinsurance were suggested.MethodsThrough literature review, this article summarized the reason of the outpatientfees’ rising, measures and outpatient fee control experience in foreign and domestic.Via internet and Nanjing municipal human resources and social security bureau,urban residential medical insurance and its outpatient finance scheme were collected.Date from Nanjing urban residential medical insurance was analyzed by SPSSsoftware. The total outpatient costs, outpatient average cost of fees, outpatientcompensate passengers, and out-patient compensation were obtained.ResultsThe advancing medical technology, the wide spreading healthcare service, theaging population, the prevailing chronicle disease, the supplier’s inducing demand,and the imbalanced distribution of health source play a vital role of the outpatientfees’ rising.The demand-side and the supply-side control mechanism of medical insuranceoutpatient fees is the direction of its development. The development of communityhealth services, payment method reform and strengthening insured residents’awareness of the fees were main measures to control medical insurance outpatientexpenses. By analyzing outpatient finance scheme and solution of severe disease ofJiangsu Nanjing urban residential medical insurance, Nanjing residents’ averageoutpatient fee had not been significantly raised. However, there existed problemssuch as fund at risk, fast growing total outpatient spending, and people’s inclinationto go to excellent hospitals, high drug expenditure and close compensation rate in allmedical sectors.ConclusionsThe author suggested that there was a urge to enhance the communityhealthcare service, to set up a comprehensive demander-oriented price controlmechanism, especially the supplier’s behavior control, and to enhance the ability ofmanagement, in an effort to improve the outpatient price control in urban residentialmedical assurance.