Violation Of Medical Treatment Insurance System Research And Health Care Physicians

Rising health care costs has become a global problem, along with the medical insurancesystem to achieve seamless coverage of all groups in our country, more and more peopleenjoy medical insurance, medical insurance system running smoothly by the highpharmaceutical the impact of the costs. At present, medical institutions and medical personneltend to the interests of, prescribe more drugs and the use of large-scale new inspectionequipment has become very common, dominated by medical personnel in thephysician-patient relationship, for supply-side, as the demand side of the patients demand canonly be decided unilaterally by the medical staff, and difficult to refuse the choice ofhigh-priced inspection and high-priced drugs. Plus medical staff salaries and bonuses linkedto the business income and the realities of the drug marketing, rebate commission, the medicalstaff is difficult due to illness and treatment.The implementation of the Medicare physician system is of great significance, can beeffective in reducing violations of the patient parties. Relatively low cost of supervision ofphysicians to provide better medical services, training practitioners of the medical insurancefor the insured to provide medical services, starting from the point of view of saving healthcare costs for patients, patients take the initiative to save costs, and safeguard the interests ofpatients, to achieve spend money less, service is good, optimistic about the disease, reduce theburden of the individual patient. Urge the physician reasonable inspection of the rational useof drugs, proper treatment, and institutional constraints to the doctor due to illness andtreatment, to prescription, do not check the abuse, did not induce over-consumption andreduce the quality of service. Strengthen the responsibility of every health care physicianspatient care about their heart, for the insured service is good, good protection. Control healthcare costs and unreasonable expenditure to ensure the healthy and stable running of themedical insurance system. Specification designated medical institutions, practitioners,medical practices, to ensure the safe operation of medical insurance. Consciously enhance thequality of medical services to the medical staff through standardized medical practices, whileat the same time reduce the health insurance fund loss, to achieve medical, insurance, risk ofwin-win situation.In this study, use of literature, drawing on the control and supervision of physicians to reduce offending experiences and practices to social health insurance institutions of theUnited States, Germany, France and other countries medical insurance violations, violationscontrol method and effect of domestic medical insurance summarized ; use of survey research,combined with the Dongying City actual situation to discuss the rationality and feasibility ofthe implementation of Medicare physician. Comparative approach, linking theory withpractice, theory of economics, management science, sociology and other disciplines of healthinsurance violation control analysis.Full Text In addition to the Introduction and Conclusion, mainly divided into five partsof the discourse:The first part defines the meaning of Medicare physician system, described the mainfeatures of the Medicare physician system, the specific content as well as around theexploration and practice, and then analyzed and discussed the Medicare physician systemshould establish the working mechanism.The second part of Medicare physician irregularities analysis, start with the irregularitiescause of the medical staff that because of both supply and demand information asymmetry,moral hazard lead to violations generally occur; followed by medical personnel and healthinsurance agencies The relationship between the application of game theory principle; againfrom the point of view of health care suffering from a tripartite representation of theirrespective non-compliance performance, a summary of the consequences of the Medicarephysician non-compliance.The third part discusses the control of the violation of China health care physicians, thefirst is to strengthen the credit system; followed by reform of the medical insurance payment;again, to strengthen supervision and management functions of health care, drug supervisionand management, health care regulators discussed from medical institutions costs on theupstream, midstream and downstream reaches of the meaning of regulation the final proposalto change the income distribution of medical personnel that the promotion of essential drugsystem, to reduce Medicare physician violations opportunity to promote the Medicarephysician self-discipline, reducing health insurance violation occurs.The fourth section describes the urban basic medical insurance health in Dongying City,combined with Medicare typical non-compliance cases and data, and analysis of DongyingCity, health insurance and regulatory situation that health insurance regulators should be fine, professional transition. And introduce the experience of Dongying City, violation of medicalinstitutions, health care physician, the insured tripartite control.The fifth section of the Medicare physician system improves the proposedcountermeasures. First, the establishment of the Medicare physician system regulatory model,clear to the Medicare physician supervision direction, put forward specific requirements onthe implementation of the Medicare physician system. The second is through thestrengthening of the audit team building, to increase penalties for violations of medicalinstitutions and health care physicians, to speed up the discourse of health insurancelegislation should increase enforcement of Medicare physician system. Third, we urge theMedicare physician to establish a good medical ethics, to reduce the violation occurs. Fourth,establish a system of information disclosure between doctors and patients to minimize theinformation asymmetry between the designated medical institutions, health care physiciansand insured patients.