Research On Medical Expense Control Strategy Between Government, Hospital And Patient In China

Objectives:Analyzing the behavior characteristic of the government, the hospital, and the public in the process of medical expense control and its influence to medical expense increase, establishing the behavior model; Theoretically constructing the entrusting and the agent system of the government, the hospital, the public in the medical expense control, and providing the corresponding policy to explain, exploration the harmonious interaction mechanism in the government, the hospital and the public, to provide the policy-making basis and the new policy mentality in solving the excessively quickly growing of medical expense for the government, thus providing the policy basis for the realization society harmonious development.Methods:Literature methodology: Consulting massive domestic and foreign public literature and the research results about the medical expense development situation and the control, also the government, the hospital and the public gambles.Thorough interview methodology: This research has carried on repeatedly interview and strict proof in the medical expense correlation main body behavior, the influence of the behavior to medical expense and investigation content. completing in participation of experts of Tongji Medical college, hospital chief, sanitation bureau administrative personnel.Questionnaire survey methodology: Using the standardized questionnaire survey, in view of the government representatives, the hospital superintendent and the patient separately designs the questionnaire, to obtain the related information on the tripartite behavior characteristic and its the influence factor in the process of controlling expense. Statistical Analysis methods:Univariate Analysis:Chi-square for variable data; Multivariate Analysis:Unconditional Logistic Regression; All data are input by using Microsoft Office Excel 2003 and processed by SPSS for Windows 11.5.Results:1.The economic analysis of the government behavior in medical expenses control The theoretical analysis result of the government behavior showed that, Government's value lies in the maintenance and the development society public interest,its behavior goal orientation is maintenance harmonious and stable development. But in real life, the government benefit may be the public interest which the government represents, also may be the benefit from the government authority. This is easy to form the government behavior to be in a dilemma, when the government benefit has surmounted the public interest, the government behavior is on performance for government function vacancy or function limit.Government's behavior analysis in the medical health organizational reform demonstrated that, In the market economy organizational reform period, to the government,On the one hand the government must use the measures under the planned economy system "the multi-purpose government" and the correlative health policies and measures to maintain oneself is the public health main policy-maker and the investment, on the other hand, government's financial resource satisfy the request with difficulty which the public health rapid development and the people health service demand unceasingly enhances.The government's behavioral analysis result in the process medical expense controlled demonstrated that, The government also falls into in the benefit difficult position - both to have to consider own economical financial resource and to have to consider solving the patient to see a doctor with much money.2. The economic analysis of the hospital behavior in medical expenses control The hospital behavior analysis result showed that, The hospital behavior value orientation often has the ambiguity, one is pursuing the economic benefit; The other is the public benefit.The research on hospital showed that, in 1998-2005 year the gross income and the gross expense in the general hospitals of ministry of health is synchronized increasing, and its service disbursement and the service income nearly superposed. The quantity increase of the hospital service providing are not many, the speed is not quick, obviously is lower than the speed of the hospital income increase. Each doctor's working load rate of rise drops year by year, even at the same time no longer grows, their year service income actually fast grows. The medical expense of each outpatient service, the everyday bed expense of leaving the hospital as well as the average medical expense of leaving the hospital is rising year by year, namely the unit service expense is rising. In the leaving the hospital average medical expense constitution per person, the proportion of Chinese native medicine and the inspection expense account for the medical expense grows slowly, has the tendency to drop.3. The economic analysis of the patient behavior in medical expenses control The outpatient's consciousness of controlling spending has statistical significance in the difference of age and income. The inpatient's consciousness of controlling spending has statistical significance in the difference of culture, income and registered permanent address. But in sex, occupation, inhabited area and the form of medicare, the difference of the outpatient's and inpatient's consciousness of controlling spending have no statistical significance. The difference of the outpatient's and inpatient's consciousness of controlling spending have statistical significance in treatment situation.The outpatient and inpatient paying attention to the medical expense information has no statistical difference in the aspect of medicare, and both pay attention to the medical expense information. The difference of the inpatient's consciousness of controlling spending has statistical significance when they choose a doctor.The check-up of outpatient has no statistical difference in consciousness of controlling spending, but has statistical difference in the form of medicare. The check-up of inpatient has statistical difference in consciousness of controlling spending. In the attitude to check-up, the inpatient participating in medicare and having consciousness of controlling spending have no statistical difference.The outpatient requesting doctors to prescribe cheap medicine has statistical difference in consciousness of controlling spending. The outpatient and inpatient to choose the medicine have statistical difference in consciousness of controlling spending. The outpatient and inpatient to buy the medicine in the hospital pharmacy have in statistical difference in consciousness of controlling spending. Inpatient to choose the medical consuming material has no statistical difference in consciousness of controlling spending. Unconditional Logistic regression analysis result showed that the factor that influence outpatient's consciousness of controlling spending has related to concerning medical expense and choosing drug; the factor that influence outpatient's consciousness of controlling spending has related to the month income and buy the medicine in the hospital pharmacy.Conclusions:1. Proposed the government behavior characteristic in the medical expense control, namely the government is the supplying main body in medical expense control policy; The government is the main body of macroeconomic regulation and control; The public welfare of government behavior in medical expense control. And construct the government control medical expense growth model acted according to its behavior characteristic to.2. Responding to our country medical expense control policy ,the hospital has its own initiative to take measures to reduce the expense of drugs and checking-up, at the same time, the increase of hospital service income is actually depending on enhancing the unit service expense, and unit service expense enhancement is through increasing service intensity. Proposed the hospital control medical expense model and the hospital medical expense growth model according to the above conclusion.3. Proposed patient's characteristic in medical expense control, go-aheadism and passivity. In the aspect of attention to medical expense information, two choices are consistent - the outpatient and inpatient having control spending consciousness both initiative pay attention to medical expense. But in the aspect of selecting checking-up, the choice of medicine and purchasing the drugs in the hospital after seeing a doctor, two choices is also the same in having control spending consciousness, both obeys doctor to arrange, both displays the passivity in controlling spending. This also obtains the confirmation in the multi-factor analysis. This result on the one hand confirmed that the patient causes the drugs and the inspection choice passivity because of the healthy rigid demand; On the other hand explained doctor has the information superiority, has appears the moral risk to induce the factor. Constructed the behavior model of patient growing the medical expense according to the above research.4. The harmoniously interacting mechanism research of the government, the hospital and the patient in medical expenses controlUnited the fundamental research and the demonstration analysis result discussion, this article finally summarized the entrusting and the agent system of the government, the hospital, the public in the medical expense control. The entrusting and the agent system at least have the following several groups relationships, Medicare organization and patient; Medicare organization and hospital; Patient and medical service provider; Patient and government; Government and hospital as well as with medicare organization.Then according to the entrusting and the agent system, from the system angle, studies the relationships between the three aspect, discussing the deep level questions behind the gambling behavior, constructs the tripartite harmonious interaction mechanism in medical expense control. This interaction mechanism had considered the alternately relations between the different relationships and the concrete strategy, simultaneously can reflect along with the change of the correlation main body, the change which the control medical expense strategy occurs.5. Constructed the frame of hospital self-encouragement restraint mechanism, summarizes for four aspects such as establishing and consummating the hospital interior system, the market competition mechanism introduction, constructing the harmonious hospital culture, the doctors'quality distinguishing. Concretely said, the inspirit and restraint mechanism construction of medical organization including the following several aspects: Improvement medical organization interior structure; Designing the superintendent reward mechanism; Building the competition the market environment, strengthens the market competition restraint; Establishing superintendent's professional risk mechanism, strengthening the professional risk restraint; Establishing scientific hospital culture; Strengthening doctors'moral cultivation .6. According to the entrusting and the agent relations as well as the interaction mechanism construct the government medical expense control policy frame. Its value orientation is "take the people as the basic, the government leads, systemically control, system innovation, moral cultivation". The content of policy frame includes: In the government decision-making aspect, strengthening the government invest, manifests the government responsibility; Constructing the legal framework of government regulation; Further thorough reforming drugs inviting public bidding system; Establishing the necessary system of the community health service system as soon as possible; In the hospital decision-making aspect, Establishing the hospital self-encouragement restraint mechanism; Improvement the payment system to medical organization; Strengthening the restriction to the medical service supplier and the construction of regulative system; Establishment the system reducing the medical information asymmetry; Establishment the work mechanism fathering commercial bribe; Establishment qualifications punishment system, restraining and standardizing the behavior of medical organization and doctors from the system; In the patient decision-making aspect, Establishment scientific medical rescue work mechanism, safeguard the basic medical service demand of weak crowd; Constructing the system platform that various social strata can equality participate, supporting the benefit adjustment mechanism of the patient right safeguard organization; Strengthening inhabitants'health education and promotion; Establishment the system of restraining consumer moral risk.