Evaluation Of The Effect Of Medical Insurance Prospective Payment System On Medicare Cost Control

Objective:In recent years,with the gradual improvement of the medical insurance system,the increase of national health investment."Medical treatment is difficult and expensive" problem was initially alleviated,but the medical insurance fund payment pressure increased rapidly.The state in order to control medical expenses rising too fast,and to reduce the payment of medical insurance fund payment pressure,it began to explore various forms of health insurance fund payment,global budget is one of them.Global budget can give full play to the medical service providers' enthusiasm of cost control,so it is a type of medical insurance payment that country has advocated in recent years.This paper mainly investigates the concrete implementation of global budget in hospitals,analyzes the problems and the impact of global budget that exist in the implementation process,and puts forward the specific suggestions according to the problems,to offer reference of effective implementation of the global budget in the relevant hospitals and the government departments decision making.Methods:Combined with all levels of government.Health administrative departments issued the relevant documents and information,analyzes the implementation of the global budget in the hospitals.Including the growth rate,structural changing degree,structural changing degree's contribution rate and ect.of the total expense,the average expense,the average medicine expense,the average materials expense,and the average examination expense that after global budget was carried out..Results:Medical insurance patients' hospitalization expenses in 2010-2016 were analyzed.The top four of the medical expenses in the hospital were medicine expenses,materials fees,inspection fees and laboratory fees,among which the proportion of medicine expenses is the highest,and have the most impact on the medical expenses.Analyzed in the structure ratio of medical insurance expenses between different departments,in which the top two are drugs and materials.From the medical expenses incurred in all ages,the cost is increasing as the age increases.Compared with the medical expenses of those who are less than 40 years old patients and more than 60 years old patients,the overall increase is significant,and the increase in medicine expenses and material fee are particularly evident.Analysis of differences in medical insurance costs between different years,found that P>0.01,no statistically significant.The structural changing degree analysis shows that the largest structural changing degree is 11.62%in the year of 2015-2016,while the smallest structural changing degree is 2.61%in the year of 2014-2015,and The total structural changing degree is 18.14%in the year of 2010-2016,of which the medicine expenses in 2013-2014 are the positive changes,the rest of the years are negative changes;material fees are all positive changes the structural changes values of inspection fees,laboratory fees and treatment costs are positive changes in general;radiation fees are negative changes;surgical costs in 2015-2016 are the positive changes,while the rest years are negative changes.In 2010-2016,the largest structural changing degree's contribution rate of medical expenses is the medicine expenses of the contribution rate of 30.80%;followed by material fees of the contribution rate of 22.93%.The contribution rate of the test fees is 10.51%,the contribution rate of the treatment fees is 9.51%,the contribution rate of those is relatively high,the contribution rate of surgical costs which reflect the doctors'moving value is only 4.10%.In the single disease,the largest structural changing degree was medicine expenses and material fees,and in different diseases,the structural changing degree's contribution rate of the material fees was the highest.Conclusion:With the implementation of the medical insurance global budget as an opportunity,through the strengthening of internal management to improve the quality of medical services and cost management,for a useful exploration to the establishment of"medical insurance on the growth of medical expenses control mechanism".In global budget implementation period,we found that medicine expenses and material fees in medical insurance patients's medical expenses take the largest proportion.Material fees,inspection fees,treatment costs are the main items which cause the increase in hospitalization expenses' structural changing degree,in which the structural changing degree's contribution rate of material fees is the largest.Structure changing degree and structural changing degree's contribution rate of health insurance varies with different departments,different diseases,different costs.The state and the government should further deepen the reform of the medical and health system,clarify the functional orientation of the medical institutions,promote the reform of the payment system,improve the classification and treatment system and the zero-rate policy of the drugs,improve the basic medical security level and reduce the medical burden of the patients.