Current Situation And Development Countermeasures Of Medical Insurance Management In Stomatological Hospital

At present,China’s oral health insurance coverage is very narrow,which can not satisfy the oral medical needs of patients effectively.High medical expenses cause great economic pressure to patients,and ultimately lead to the spread of oral diseases,and induce the occurrence of some other diseases while hospitalization.On the one hand,the situation is undoubtedly worse for the patient,on the other hand,the situation also increase the burden for the medical system.The developed countries pay more attention to oral diseases,establish and improve the oral health insurance system,especially in the United States,Germany,Japan.Oral health care system of our country is far from meeting the needs of patients.Combined with Chinese condition,improving the oral medical insurance system will play an important role in ensuring the quality of oral public health services.Objectives:This subject is divided into two parts to analyze and study the current situation of medical insurance management in the stomatological hospital.In order to study on the current situation of outpatient medical insurance management in stomatological hospital,the first step is to know the outpatients general payment situation and the methods.The next step is to know the current payment status and health insurance needs of outpatient.According to the results of the research,putting forward feasible suggestions of incorporating our country’s oral diseases into the basic medical insurance.Studying on the current situation of hospitalized medical insurance management in stomatological hospital,the main investigation will focus on the quota exceeding hospitalized costs condition of medical insurance patients,and find the factors of the exceeding costs,then,to explore the causes of the factors,and put forward its preventive measures.Eventually leading to put forward the development strategies of stomatological hospital’s medical insurance management.Methods:In order to study on the current situation of outpatient medical insurance management in stomatological hospital,the questionnaire survey was used to establish the database for sorting the data and performing the chi-square test to understand the change of oral hospital outpatient payment method.Through the survey to collect the time between2011-2016 outpatients information data to establish a database,to use SPSS for statistical description,to understand the current oral outpatients health insurance payment status.For the lower proportion of medical insurance payments,the network survey method was used to comparative analysis of pilot cases of oral diseases into basic medical insurance outpatient treatment projects in some areas of China,and put forward a feasible suggestion of incorporating our country’s oral diseases into the basic medical insurance.In order to study on the current situation of hospitalized medical insurance management in stomatological hospital,the survey collected and established a database for the medical insurance patient’s hospitalized costs from 2014 to 2016 to know their over quota cost,and found the factor why the medical insurance patient’s hospitalized costs exceed the quota through factor analysis.Then,the survey established the database forcollecting data for the nearly three years maxillofacial tumor patients’ cost,and used multiple factors logistic regression analysis method to test various over quota,found the influential factor of maxillofacial tumor patients’ cost over quota,and then explore the causes of the influencing factors.Results:1.Comparative analysis for general situation and payment related problems of the oral hospital outpatient patients for 20 years.Issued a total of 2512 questionnaires in 1994,2004 and 2014,comparative analysis shows that age,education level,family income,occupation,the distance of the treatment,the treatment of transport,medical expenses and other changes in the treatment of patients with statistical significance(p<0.05);Those under the age of 18,high education,high income to oral hospital patients were significantly maintained at a high level.In 1994,2004 or 1994,the cost of medical expenses was mainly at their own expense,45.18 percent in 1994,59.11 percent in 2004,71.6 percent in 2014,and still continue to increase.2.Comparative Study on the payment methods of oral medical fees in oral outpatientsBased on the data of oral medical expenses for a total of 6 years from 2011 to 2016,the comparative analysis showed that the proportion of CUP payments increased from44.68% in 2011 to 61.33% in 2016;the proportion of treatment fees increased from85.11% in 2011 to 87.84% in 2016;the proportion of medical insurance payments increased from 7.05% in 2011 to 11.12% in 2016.Medicare payments are increasing year by year,but are still at a lower level than at their own expense.3.Status and analysis of putting oral disease into the basic medical insurance outpatient treatment project pilot situation.There are four areas have brought oral disease into the basic medical insurance outpatient treatment project in our country.By comparing the basic oral diseases such as:pulp disease,periapical disease,periodontitis and other identified as the basic medical insurance treatment project conditions,it suggested bringing oral diseases into urbanworkers basic medical insurance outpatient treatment costs package settlement project standards(recommendations).4.Investigation and analysis of the oral hospital outpatient patients’ hospitalization expenses over quota.The survey obtained the hospitalization expenses of a stomatological hospital medicare hospitalized patients for a total of 3 years from 2014 to 2016.the results showed that inpatient departments,liquidation mode,personnel categories has statistical significance to over quota(p<0.05),the over quota of maxillofacial tumor is the highest,76.11% in 2014 and 70.76% in 2015 increased to 81.29% in 2016;Over quota of single disease is the highest,from 431.2 thousand yuan in 2014 to 609.2 thousand,the over quota rate minimum is 96.36% per year from 2014 to 2016;the highest is urban employee,the over quota rate increased from 60.43% in 2014,70.09% in 2015 to 69.50% in 2016.5.Analysis on the oral hospital outpatient patients with maxillofacial tumor hospitalization expenses over quota.It made a deep analysis on the factors of affect over quota,collect the hospitalization expenses of a stomatological hospital medicare hospitalized patients with maxillofacial tumor for a total of nearly 3 years.The results show that tumor character,tumor type,personnel category,liquidation mode has statistical significance to over quota(p<0.05),the highest is therioma,over quota rate increased from 476.2 thousand yuan in 2014,771.9thousand yuan in 2015 to 935.3 thousand in 2016;Over quota of single disease is the highest,from 416.8 thousand yuan in 2014,595.6 thousand yuan in 2015 to 601.8thousand in 2016,the probability of over quota basically maintained at about 90%;Over quota of enterprise staff is the highest,from 354.2 thousand yuan in 2014,545.1 thousand yuan in 2015 to 702.2 thousand in 2016,over quota range increased from 74.31% to77.14%.6.Project status and analysis of the basic medical insurance for urban employee medical insurance.Various areas of urban workers on the basic medical insurance inpatient disease projects have oral disease items in our country.At present,our country practices principleof single disease payment,most of which are reimbursed only for surgical treatment of single diseases,and inpatient only.The survey collected oral diseases in 6 areas(xi’an,Qingdao and Nan yang etc.)on the basic medical insurance for urban employee medical insurance,comparative analysis put forward our country’s basic medical insurance for urban employee(Stomatology Department)directory standard(recommendations).Conclusions:The study showed that patients had significant increase in patients under 18 years of age,significantly lower in patients of middle and lower income families,and significantly lower in patients of lower educational background.Medical payment is given priority to with at patients’ own expense.The scope of coverage is relatively narrow for outpatient.Health care payment increased year by year,but compared with pay by their own is still in lower level.The paper puts forward the standards(suggestions)for the inclusion of oral disease in the medical insurance of urban workers.Studies have shown that hospitalized patients expenses exceed phenomenon is extremely serious,The nature of the tumor,tumor category,and liquidation way are the main factors affecting hospitalization expense,the prevention and control measures of Medicare patients hospitalization exceed expenses are put forward.This paper puts forward the catalogue standard(suggestion)for the hospitalization of basic medical insurance for urban workers in China.In the end,the countermeasures for the development of the medical care management in the hospital are put forward.