The Study Of The Relationship Between Medical Expenses And Medical Conduct During The Development Of Civil Basic Medical Insurance

As one of the social security system, the medical insurance system is very important, which is related with the progress and stabilization of our society. Now many countries are exploring and studying the reform of the medical insurance system and attempt to find a suitable indemnification, which can use the limited medical resource to satisfy the need of people's health to the greatest extent. The realization of this objective requires us to improve the justice of allocation and the efficiency of utilization. Policy control the medical costs and reduce the speed of medical expends so fast that could ensure the people's health and reduce the pressure in finance of the government. In this condition, China has established the new model of medical insurance system. It has been more than ten years since the first experiment in "LIANGJIANG", and now the new system has been generalized all over the country. This article analyzes the difference of medical expense between individual of medicare and non-medicare in two large hospitals in Jilin Province. By using the computer program of visual foxpro and excel, author contrast the two group patients'medical expense, especially the constitute of the fee and some relative items and draw the conclusion that is the consumption of people who have take part in the medical insurance is higher than those who haven't any medical insurance. Further research, author finds that under different system of medical insurance people who has a superior insurance will almost consume much more than those who has a inferior or no insurance. This phenomenon indicates that the establishment of medical insurance policy directly infects the variation of medical expenditure. Furthermore, under one same medical insurance system, between different hospitals which are both sanjia hospital but has different policy in medical conduct management, there has been an obvious difference in the medical expenditure. The ratio about kinds of medical expenditure shows the injustice and the waste of medical resources. The new medicine directory of medical insurance has been changed in 2005 and taken it as an intervene factor, author contrasts the medical expenses between adopting the old directory and adopting the new directory, the result is that the expenditure is lower than that of before, especially expenditure of drug. It shows that the restriction of policy on hospital's medical conduct influences the medical expenditure. Considering the system that is imperfect and the characteristic of medical service and consumption, this article analyzes the expression of improper medical conduct and discusses the moral risk's source in theory and the consequence. In the article, author uses the "economic man"hypothesis to explain hospital, medical insurance, patient who has the medical insurance to seek for their interests, acts as three different individual, which is because of the economic men's selfish motive. The game theory can explain that the three different individuals will make the best choice in their action so that every party can get the best benefit under a fixed and restricted condition. The three parties satisfy each other to reach get the best choice. Such state is the ideal state that ours medical insurance system reform aims for. By introducing the medicine ethnics, author demonstrates the ideal medical conduct, illustrates the measure and advices to prevent the moral risk in medical insurance. At last, this article points out that the medical expenses are directlyinfluenced by the medical conduct during the course of medical insurance, which could continually perfect the relation between the imperfect medical insurance system and the improper medical conduct, which are conflicted and unified, can facilitate the medical insurance system and accelerate the development of medical insurance enterprise. It's important to analyze carefully the relation between the medical system and the medical conduct during the progress of our country's medical insurance system reform, which benefit control medical expenses and ensure the people's health, provide the help in theory and practice for the medical insurance enterprise's development.