Research On Influencing Factors And Control Strategies Of Medical Expenses Of Insured Groups Under The Background Of Universal Medical Insurance ——Taking A Tertiary Hospital In Shandong Province As An Example

In 1951,my country promulgated the "Regulations of the People’s Republic of China on Labor Insurance",which marked the beginning of the construction of the social medical insurance system.After more than 70 years of development,my country has basically achieved the nationwide coverage of the social medical insurance system.In recent years,the continuous growth of medical expenses has led to an increase in the expenditure of my country’s social medical insurance fund year by year,which not only brings difficulties to the stable operation of my country’s medical insurance fund,but also brings a huge economic burden to the vast number of sick people.In addition to the cost increase and inflation caused by the medical cost itself,there are also some controllable medical cost increase factors.Since 1994,my country has continuously explored the reform of the medical insurance system,the social medical insurance system has been continuously reformed and improved,the medical security effect and the level of health security for the general public have been significantly improved,and the growth trend of medical expenses has been controlled to a certain extent.The increase in expenses has been controlled to a certain extent,but the problem of "expensive medical treatment" still exists.Medical expenses are still one of the main burdens of residents,and it has also become a financial burden for the government and hinders the sustainable development of my country’s medical security.Therefore,targeted measures are taken.Appropriate means to effectively control medical expenses is not only conducive to solving the public’s burden of medical treatment,effectively relieving the government’s expenditure pressure on medical insurance funds,but also has positive significance for the sustainable development of my country’s social medical insurance.On the basis of the current situation of medical cost control in my country,this paper first introduces the background of my country’s universal medical insurance and the theoretical basis related to cost control;The total medical expenses and the current situation and characteristics of inpatient medical expenses in our country are introduced,and the cost control measures adopted in our country are introduced.Secondly,taking a tertiary hospital in Shandong Province as an example,according to the medical expense data of a tertiary hospital in Shandong Province,three typical diseases of coronary heart disease,fracture,and lung cancer were selected from the microscopic level.Analysis of the changes and proportions of the total inpatient medical expenses and their constituent expenses（medical expenses,examination fees,inspection fees,treatment fees,consumables fees and operation fees）from 2014 to 2018 in terms of three different types of resident medical insurance.Preliminary statistics and analysis of the inpatient medical expenses of a tertiary hospital in Shandong Province,and found that the medical expenses of patients with different medical insurance types vary significantly,the proportion of medical expenses is still high,and the proportion of inspection and testing expenses continues to increase;On the basis of the analysis,the data of inpatients in 2018 were selected for regression analysis,and the generalized linear model was used to analyze the influencing factors of medical expenses.The analysis showed that the type of medical insurance,the number of days of hospitalization,and whether or not the hospitalization medical expenses had a greater impact.On this basis The current problems in medical cost control were analyzed,and it was found that the length of hospital stay,the uneven use and distribution of medical service resources and other problems existed in the process of hospitalization of patients.Reasonable and long-term targeted control measures are put forward in five aspects: hospitalization,reduction of unnecessary operations,reduction of medical expenses and control of unreasonable inspection,inspection and consumable costs.Development discussion,and put forward feasible ideas for good and stable development.