Analysis Of Medical Expenses And Policy On Outpatient With Medical Insurance

Objective:To explore the multiple factors on the utilization of outpatient' medical care, by the collection of outpatient' medical expenditures for urban worker and resident in Xiangfan city, outpatient' costs in different-level hospital and structure of insured population, reflect the situation of outpatients' cost by analyzing the influence factors on insured outpatients' costs, providing the effective policy of controlling and utilizing medical expenses reasonably.Methods:Adopting the random sampling method, chose 2 for each primary, secondary and tertiary hospital respectively and surveyed the total 403 outpatients with questionnaires; checked the situations on outpatient' costs and personal accounts with medical insurance, using descriptive analysis, single and multiple factors combining analysis, including chi-square test, rank sum test and variance analysis .etc; All above associated kinetic study were to provide an effective basis for the following policies in this research which were for the current community construction.Results:(1) Hospital level is the most significant factor (P<0.05) on the medical expenditures, Medical expenditures for each outpatient in primary hospital is the highest which is about 289.5yuan, ones in the secondary hospital and community are about 126.6 and 61.9yuan respectively;(2) Analyzing the different factors on each hospital Medicare, the general hospital impression, physician, nursing and pharmaceutical services, transportation conditions, hospital charges, service attitude of hospital and hospital fame are the significant factors on patient's treatment (p<0.05), however, friend and relative'recommendations, registration services and health satisfaction had no significant meanings (p>0.05);(3) Through the analysis of the factors on outpatient's treatment, we found that main factors on outpatient's treatment in the order of importance are convenience, service attitude of hospital, medical quality, low charges of hospital and so on, accounting for 26.6%, 21.7%, 19.3% and 16.3% respectively, which are the most significant factors affecting outpatient's diversion(p<0.05);(4)During the period of 2007-2009, expenses in personal account for urban worker with medical insurance concentrated in primary hospital, comparatively community took the less part. By the rise of chronic fees for outpatients annually, and fees in primary hospital tended to a stable state, the community part was the opposite.Conclusions:By the official lead and supervision, as well as the Government comprehensive funding, the tilt of reimbursement policy, accelerate the community's construction and improve the system of basic service construction for urban, widen the scope of reimbursement ratio between hospital and community. Through the way to improve information system, achieve two-side referral between hospital and community to enhance community's technology in the background of hospital group.