Medical Cost Difference Analysis Of The In-patients In Medical Insurance And Of Those On Their Own Expenses In The Operation Department

Most areas (98%) of our country have started up the medical insurance system up to 2004. The reform to it has made progress in the phasal sense and has made the institutional transition and the mechanism conversion come true. However, the reform also exposed some weaknesses in expense control in the same time. Ministry of Health provides a new sta that medical costs in recent years has increased rapidly, the data shows that from 1980 to 1998 , the total health expenditure has grown 10 percent on average a year . it has grown 13 percent a year in outpatient services and 11 percent in in-patient services. State sanitation economy , the elastic coefficient of health care service in recent 10 years (the ratio of the total cost rate to the GDP rate,1—1.2 in reason) has fluctuated from 0.63 to 2.02 . It indicated the out-of-line between sanitation development and civil economic development. The current system didn't confirm the concrete payment mode adopted by the basic medical insurance. Except for few cities , most cities still adopted the fee-for-service mode which has already been validated irrational by international experience. The overload of medical cost is still one of the main reasons of poverty. Thus the research of cost control is a very important issue in the medical insurance policy study.The investigation analyze the data of "The analytical system of total information in hospital" from one of first choice medical insurance "Fist Class at Third Grade" hospital in JiNan city. According to the frequency of cases in some surgical common diseases from 2004 to 2006 in hospital, 5 diseases' cost was studied including gall stone, malignant tumor in lung, in stomach, in esophagus and hyperplasia of prostate gland. The data was taked sample from patients of medical insurance and own expenses according to 1:1 rate through proportional sampling principle. The variability analyze of the two different type patients' cost was used nonparametric test. The study was analyzed the in-patient cost for 1160 patients of medical insurance and own expenses who got above disease to find out the distributing and structure in one of "Fist Class at Third Grade" hospital in Shandong province.(1) To find out the common statistics of the in-patient cost;(2) To find out the distributing and structure of the cost in patients of medical insurance and own expenses;(3) To discuss and table a proposal for consummating the institution according to the result and research.In this research, for each of the five diseases, the cost of the inpatients in medical insurance is higher than those at their own expenses ,however there is no statastic difference between them; the average time is from 9.83 day to 23.62 day; the in-patient time of the patients in medical insurance is longer than the latter,while the cost of the treatment,operation,enalsethics is lower than the latter.The cost of operation,medicine and treatment has taken a great ratio, the cost is obviously different in different diseases; the structure of the cost is different. Controlling the cost of operation and medicine can effectively decrease the in-patient cost., It is a nessary method to controll the medical cost into a benigh circulation through the medical insurance system.[SUGGESTIONS]:(1) Optimize the service progress,feform the pay system,realize the single-disease way and DRGs cost -controll model.,explore the way of prepaying for cost in diferent disease.(2) Esteblish the exclusive management system and realize the fee-management methods.