Study On The Influence Of Hospital Medical Expenses Control Early Warning System On The Control Effect Of Medical Expenditure

The excessive growth of medical expenses has brought great pressure on the medical security industry and the stable development of the society in various countries.Therefore,governments are exploring measures to control the excessive growth of medical expenses.The practical experience of developed countries has found that the information management of medical insurance is an important measure to control the excessive growth of medical expenses.Some developed countries have established a relatively complete medical insurance information management system.Some developed cities in China have also learned from foreign experience,and established a medical insurance information management system suitable for China’s national conditions,which realized the real-time settlement and cost audit of medical expenses,however,the review of medical expenses in these systems are still based on post-mortem review.At the stage,only the medical expenses that have already occurred can be reviewed and controlled.It has not established a complete medical expense audit and cost control system.Therefore,based on the experience of all parties,and based on the fact that the hospital is both a provider of medical services and the main carrier for controlling medical expenses.Therefore,the gate for controlling medical expenses is moved forward,and a hospital is established in the medical insurance designated hospital.The medical expenses control early warning system realizes the control of medical expenses in the hospital.This study draws on the experience of all parties,and bases on the fact that the hospital is both a provider of medical services and the main carrier for controlling medical expenses.Therefore,the gate for controlling medical expenses is moved forward,and a set of medical cost control early warning is established in the hospital.The system realizes the control of medical expenses in the hospital.The paper work is as follows.1.Design of medical cost control early warning system.First of all,the indicators for early warning monitoring were determined according to the Anhui medical insurance institutions’ assessment indicators for hospital medical expenses control,and the indicators that were finally included in the early warning monitoring included the personal payment ratio of hospitalization expenses and the per capita medical expenses.Secondly,an early warning monitoring system was formed by embedding the medical cost control early warning monitoring function module in the hospital information management system.Thirdly,the monitoring indicators of each clinical department were inputted into the early warning monitoring system,so that these indicators could be monitored in real time when the patients were admitted to the hospital.Once the self-pay ratio or per capita medical expenses exceeded the set standard,the warning system would remind clinicians to pay attention to medical expenses control.Finally,the clinician controlled the medical expenses based on the reminder of the early warning system.2.Analysis of the effect of medical expenses control in early warning system.Five clinically common diseases were selected to verify the medical cost control early warning system.Data statistical analysis method was used to analyze the differences in medical expenses and personal burden ratio between Hefei city employees’ medical insurance patients before,during and after the implementation of the early warning system,and to analyze the differences in medical expenses and personal burden ratio between medical insurance patients in Hefei city and off-site workers in Anhui province after the implementation of the early warning system,to evaluate the medical cost control effect of the early warning system.3.Analysis results of medical expenses control effect of the early warning system.The implementation of the early warning system has the most obvious effect on the control of the personal payout ratio of hospitalization expenses,and the proportion of personal burden of all diseases has dropped significantly after the implementation of the early warning system.The implementation of the early warning system was also effective in controlling the total hospitalization expenses,per capita medical expenses,drug cost,medical consumables expenses,and the proportion of drug expenses.The absolute cost of most diseases showed a significant decline after the implementation of the early warning system.The implementation of the early warning system has the worst control effect on the cost of examination,but it also has a certain control effect.The examination cost of most diseases or its growth rate has decreased after the implementation of the early warning system.It could be seen that the implementation of the early warning system has improved the hospital’s early warning and control ability for medical expenses,so that the medical expenses of the insured patients were effectively controlled after the implementation of the early warning system,and the personal burden of the insured patients was also significantly reduced.