Study On The Medical Cost Of Diabetes With Medical Insurance And The Ways Of Payment Means In China

Objective: 1. Investigates our country diabetic's medical cost in 2007, and evaluate the influence of different payment means (DRGs represented by Beijing, Wuhan and capitation represented by Guangzhou) on the medical cost mentioned above. 2. According to the result of our research, discuss how to reform current payment means from the angle of controlling medical cost.Methods: 1. The spot investigation which use the design of cluster sampling extracts three places: Beijing, Guangzhou and Wuhan, and make household survey there on the basis of designed questionnaire. The content of questionnaire contains the general characteristic of demography; the situation of common health, patient, outpatient clinic and community health services---each of them has many indicators. 2. The medicare record data which comes from medical insurance centers in Beijing, Guangzhou and Wuhan includes outpatient data, inpatient data and detailed inpatiend data. 3. Statistical analysis: Input questionnaire data using epidata3.1; Take advantage of excel to establish database and make graph; Make generally descriptive research, ANOVA, nonparameter test, x2 test and general linear model analysis by the means of sas8.2.Result:1. In the aspect of spot investigation data, the 95% confidence interval of outpatient medical cost in beijing and guangzhou in 2007 are respectively 8396.74±510.14, 3314.79±250.19, and the difference between them is significant; The 95% confidence interval of outpatient medicare reimburses in beijing and guangzhou in 2007 are respectively 6141.06±347.27, 1535.15±100.25, and the difference between them is significant; The proportion of reimburses are respectively 71.77±2.95%, 55.56±4.62%, and the difference is significant.2. In the aspect of medicare record data, we analyse outpatient data and inpatient data independently. (1) outpatient data: the 95% confidence interval of the medical cost in Beijing and Guangzhou are respectively 9803.98±423.2, 2771.87±26.39, and the difference between them is significant; The reimburses are respectively 6675.40±343.36, 1252.70±10.40, and the difference is significant; The cost paid by the patients are respectively 3128.58±131.33, 1519.18±17.44, and the difference is significant; The proportion of reimburses are respectively 61.43±1.25%, 50.95±0.12%, and the difference is significant. (2)inpatient data: the 95% confidence interval of the medical cost in Beijing Guangzhou and Wuhan are respectively 10060.75±730.30, 9915.51±267.02, 5845.67±191.21, ANOVA shows that the difference between Beijing and Guangzhou is not significant, and Wuhan is lower than them; The reimburses are respectively 7460.55±556.05, 6286.93±186.96, 3965.52±127.33, ANOVA shows that the difference between Beijing and Guangzhou is not significant, and Wuhan is lower than them; The cost paid by patients are respectively 2600.20±225.19, 3628.58±92.30, 1591.87±38.57, ANOVA shows that Guangzhou is the highest, and Beijing is higher than Wuhan.Conclusion: 1. We should enlarge the investment in the community three-level prevention, bring Disease Prevention and Health Care into medicare system. 2. More attention should be paid to control the complicaion. 3. The mild case should accept treatment in community health service center as far as possible. 4. The DRGs model which is represented by Beijing and Wuhan is better than the capitation model represented by Guangzhou from the proportion of reimburses angle. As the current economic burden for the patients are becoming more difficult, so we should genealize the DRGs model as countermeasure.