The Analysis Of The Basic Civil Medical Insurance Payment Method Reform In The City Of Zibo Summary

As high-tech and new equipment and the new drug use and spectrum of disease change, the rising incidence of chronic diseases, the aging of population and public health awareness increases, the medical service provider to induce such medical expenses and medical needs of our medical expenses growth far outran the national economic growth. In the year of2004the ministry of health in the third national health services mainly the result of investigation showed, city residents average annual income increase8.9%, and2.5%increased in the country. Urban and rural residents medical and health costs increase13.5%and11.8%respectively. The current medical expenses continued growth in the present situation shows that the existing medical insurance control measures are required more in-depth research, it is necessary to explore new or a charge of the way to control medical costs. To glance over the world medical reform, the core content is the health sector for the reform of the way to improve the efficiency of the cost of medical services-than in a sense, the reform of the medical insurance payment method is to determine whether a new medical reform to be success. In this connection, the "new medical reform scheme" articlel2wrote:of "improved health care for medical services and improve the monitoring role and payment system, actively exploring carry out to pay the fee per head, to pay the fee in entity, and amount payment in advance to establish incentives and discipline and effective control mechanisms."From the medical insurance for the pros and cons of the way analysis, basic medical insurance funds’expenditure,management of the major problems and puzzles, the faced risk of the existing foundation and related studies, this paper will focus on the payment, standards and risk prevention system of basic medical insurance for research. This paper specific introduces main content about in Zibo basic medical insurance for urban employees of the operation and in recent years by different insurance settlement, concretely analyses the factor of the fund expenditure increase and concrete fee control degree after using different ways for costs from2006to2009, picking up the data of fund management and payment from medical insurance system in zibo from2006to2009, taking a typical survey as the principal, adopting the research of combining qualitative and quantitative analysis, do data analysis study. Survey data quality inspection and evaluation:By the survey data of logical rules to be judged, and make data comparison with the health statistics yearbook. And studying and learning from foreign medical insurance of the relevant medical fees control systems in basic medical insurance payments, improves the way the notion of cost constraints to establish a mechanism to provide the scientific basis. Combining main kinds of medical insurance for the payment way to the pros and cons analysis, researching the disadvantage of existing way, put forward the direction to improve payment method and the supervision and management menthod to assort payment method.Our basic medical insurance system for urban employees are still in its infancy. Ten years later national reform, how to choose propriate payment way to the regions, further improving the basic medical services, carrying out the basic medical insurance policies, preventing medical insurance funds risk, and ensuring the rights of people who take part in the medical insurance, will be the important topics to all levels of management, experts and scholars. At present, nonstandard medical events, extracting medical insurance fund occurs frequently in Zibo and other areas. And most of the area remains post-paid settlement of accounts, lacking of data decision-making, technical support and risk prevention. Therefore, from the realities of Zibo, using for reference the domestic and international medical insurance payment method and management measures, summarizing the payment of basic medical insurance fund periodically, choosing the right payment and management of the basic medical insurance fund, establishing the basic medical insurance funds operation, risk management and preventive mechanisms, ensuring that the basic medical insurance for city and town’s residents a steady and sustainable development, have great theory and practice.