The Study On The Payment Of Social Medical Insurance Fund And Cost Control

With the accelerating process of aging, constantly changing medical technology，moreand more higher income levels of citizens that arise the medical demand, all leads to socialmedical insurance costs increased, the cost of medical insurance is also growing so rapidthat it brings an enormous expenditure pressure on the public. Social health insurance fundfacing enormous pressure to pay, payment of social health insurance fund cannot besustained manner. Therefore, to adjust our pay policy of social health insurance fund and toimprove the efficiency of social health insurance fund is the one of the key issues on thepayment reform.The thesis according to Say’s law, public finance theory, the principal-agent theoryand other theories, focusing on the game relationship of multiple interests groups formedby the supply and demand of the social health insurance services, in-depth analysis of itspresent situation, and establishing a target model of cost control as objective, by drawingon international experience and using the statistical analysis, and on the basis of empiricalresearch, and carried out a feasibility validation and analysis.The target model is toestablish the flexible budget for the budget system, increasing government spending; toachieve payment and check by way of DRG in the course of medical services; to introducemedical experts and insurance experts as "the tripartite institutions "to run medicalinsurance fund.The main part of the thesis is divided into seven parts: the first chapter, clearingmeaning and purpose of the study, putting in order the study status of the payment and costcontrol of the social health insurance fund, giving the basic method and ideas; secondchapter, defining and analyzing the basic concepts involved, to explain the theoreticalvalue on Say’s law, public finance theory, the principal-agent theory and other relatedtheories in the study; The third chapter, reviewing and analyzing the current payment andcost control system of social health Insurance Fund, and to Shanghai, for example,payment and cost control model of social health insurance funds in a typical urban as case analysis;Chapter IV, the system implementation effective of the payment and cost controlof the Shanghai’s social health insurance fund identified by empirical research, analyzingthe public satisfaction with the existing system and the desire of the reform; the fifthchapter, evaluating the policy effect of the current payment system and cost control means,clearing its positive effects and negative effects, and analyzing the causes of the negativeeffects; the sixth chapter, perfecting the payment and the cost control system of socialhealth insurance fund, and verifying the feasibility of the target mode.Chapter VII, with thetarget model as the base, proposing the macro-goal paths to realize the target model, andpolicy recommendations for the pay the cost control reforms of the social health insurancefund.