Medical Expenses Control Under Social Medical Insurance Services Commissioned Commercial Insurance Companies In Chengdu

With the expansion of the coverage of health care system, the waste of health resources is becoming a serious problem, which has beyond the level of economic level, and becomes a heavy burden on the public finances. Through the international health insurance reform, the governments introduce’managed competition’and actively promote the outsourcing of medical insurance services, in order to control the trend of medical expenses soaring.Foreign governments normally encourage the third-party to participate in the social health insurance business of government. The Governments develop a legal framework, create the appropriate competition mechanism for regulating the competition of third-party department, aimed to produce an efficient mechanism and make a health quality improvement system. Before the policy is clear in China, Taizhou, Xinxiang, Jiangyin, Zhanjiang, and other places have been firstly practiced and sum up the experience of commission business, which relieve the lack of realistic management, also ease the unproper actions of medical institutions, and lead to a shortcut of medical expenses control.Local governments commissioned the commercial insurance companies to participate in social medical insurance, which have been spread in many regions in China. The situation has undergone a spontaneous choice and practical needs, Academia summarized the core of management experience and demonstrated it in theory, then gave support and actively promoted it, and the government formulated the policy to make the interaction in2009, indicated the practical value of the new medical reform on the medical expenses control. Experts of The LTHS pointed out that, commissioned business is the only choice the underdeveloped region. Even in some prosperous places, commissioned business is a good deal to improve the funding and distribution through competition, and help control medical expenses.Based on this background, this paper attempted to adopt Literature report, Comparative analysis, Survey research and Public information research, then make a simple combination of related research on the control of medical expenses which at home and abroad. The purpose of medical expenses control is not to restrict the medical necessary but to make a reasonable mechanism of medical resource. International and domestic government actively introduce third-party administrator to participate in social health insurance business, reflect the nature of managed competition. The trend is in line with the concept of public service outsourcing in the new public management movement. This article aims to explore commission business of the mutual aid insurance in Chengdu, how to use the existing medical expenses control experience and means under the new framework, achieve a better medical expenses control results.Chapter Ⅰ is’Introduction’. First briefly explain the background and the significance of this research, leads to the subject of this article-the participation of the third party in the social health insurance system, can establish the government-led market competition situation and help solve the medical expenses problem. Then give an instruction of the article topics and content, research methods and frame, as well as the references and the website.Chapter Ⅱ is’the medical expenses control experience of foreign medical insurance system commissioned the third party’. Various countries have carried out a new round of health insurance reform in order to solve the soaring of medical expenses. The United States actively encouraged the commercial insurance companies to participate in the management of the health insurance business, the Holland government commissioned all the health insurance business to the commercial insurance companies and establish a regulatory system to regulate competition, Britain invite the Alliance of general practitioners to involved in the allocation of medical resources and build a medical expenses-constraint mechanism. All these actions reflect the concept of managed market competition led by government under the new public management, the introduction of managed competition in the field of medical insurance become a global tendency.Chapter Ⅲ is’social medical insurance organizer commissioned the commercial insurance companies to participate in and the effect on medical expenses’. Firstly introduced the status quo of China’s medical expenses control, from the monopoly conditions to the market competition in medical resources distribution, we still have a long way to go. Local government commissioned the commercial insurance companies to participate in medical insurance have spread in many regions in the country, just mean to solve the expansion pressure, and achieves the effects including quality improvement, security level increase and the save of medical expenses. Then analysis the similarities and differences in commission business between domestic and foreign countries, essentially belong to the outsourcing of public services, and rationalize the parties involved in the commission business, then put forward the realistic value of medical expenses control under commissioned mode.Chapter IV is’Chengdu social medical business commissioned the commercial insurance companies and the challenges’.In the context of Chengdu medical expenses control status and medical insurance system, make a optimal choose to make better use of commissioned managers constraint framework. Then describe the selected commission mode which can contribute the constraint of the medical expenses, and inform the new challenges which can bring. Chapter V is’the advices of Chengdu social medical insurance commission business on how to make better control of medical expenses’. In Chengdu commission business, in order to achieve a better result of expenses control, and use the experience and method of medical expenses control. Then give advices from expenses auditing, information systems, and other key process of medical expenses, also the supervision and performance evaluation in the new framework. Finally, give the conclusion that the effect of medical expenses control related to the ability of sign agreements between the government and the medical service provider. Then propose that improve the laws and policies conditions to regulate commissioned business, make the commission mode can help solve the medical expenses, with some practical guidance.The possible innovations of the paper are as followings:1. The domestic research on the commission business of medical insurance all focus on the benefits for both the social medical provider and the commercial insurance companies, not properly proposal the value of medical expenses control.2. Under the new framework, which change from the three party relationship to a four party relationship, the article make a certain exploration on how to use the previous accumulated experience and methods and do better medical expenses control. The shortcomings of the article are as followings:1. The commission business is a very practical question, limited by the search literature and information I may not make a very deep understanding on the practice.2. The result of the commission business of Chengdu mutual illness assistance not come out so far, there are not the feedback to show the effects of the medical expenses control.3. The medical expenses soaring is a complex problem, including not only the knowledge of Insurance, Finance, Economics, Public Administration and others. Limited by the theory level, there may be many items lake of consideration and enough depth.