Study On The Level Of Medical Expenditure And Medical Insurance Loss In Sichuan Province

The medical service cost is the cost which refers to the patient to carry on the diagnosis, the treatment, the guard, to receive, the birth control and other services, as well as the cost related with these services which provides the drugs, the medical material and the appliance, the ambulance, the hospital ward lodging, the meals and so on. In order to avoid the risk of the medical cost, people need to participate in the medical insurance plan, which have given rise to medical insurance loss. People who have taken part in the social medical insurance or commercial health insurance can obtain part or all of the compensation after they accepting medical service, this part of compensation is named medical insurance loss. Currently, medical expenditure has become a global issue, and it has become the key point of academic study.Presently, the problem of medical expenditure has become the key point of the domestic scholar. However, very few studies have analyzed the regional difference of it in Sichuan province. Therefore, it will be of great practical significance to use the actuarial techniques to seek the true level of medical expenditure and health insurance loss and more the medical insurance premium rate in different regions or different years in Sichuan Province. The results can be rational basis for the fund collection of social insurance and premium rate pricing of commercial health insurance, it also can be helpful to explore the fair of health care service plan and measures of medical costs controlling.In this paper, we systematically analyze the level of medical expenditure and medical insurance loss in some cities of Sichuan Province by making use of authorities released information, literature studies and statistical analysis of survey data, the main contents and conclusions are as follows:Part l,this part introduces the research background, the object of study and elaborates on the concept of medical expenditure and medical insurance loss, introduces the purpose, the method and the value of this study, and sums up the contents and results of previous studies;Part 2, making use of three kinds of data to discuss the the level of outpatient medical costs. Authorities released information indicates that the average medical fee for each outpatient in Sichuan Province is 112.91 yuan, it is 134.68yuan in Chengdu city,93.88yuan in Mianyang city, and 117.52yuan in Neijiang city. Investigation of self-organization indicates that the mean of medical fee for each outpatient in Sichuan Province is 618.68 yuan, the median is 100 yuan, the mean in Chengdu city is 549.75 yuan, the median is 100 yuan, the mean in Mianyang city is 341.31 yuan, the median is 150 yuan, the mean in Neijiang city is 993.4 yuan, the median is 100 yuan. From the result of median test, there is no difference of outpatient medical costs in three different cities.Part 3, making the use of three kinds of data to discuss the medical expenditure and medical insurance loss of patients who have taken part in the Medical insurance for urban workers and Urban and rural residents or commercial health insurance. Grouping the sample data according to the hospital level, age and sex of the patient, and analyzing statistically each group of data, besides carrying on the non-parametric statistical test to various risk groups. Studies show that medical expenditure for men is more than it for women, and with the increasing of age, medical expenditure and medical insurance loss for tertiary hospitals patient or Social Security insured patient increases, but gradually decreases for the patients with commercial medical insurance.Part 4, this part analyzes the application of the true level of medical expenditure and medical insurance loss. This part applies the results of part 2 and part 3 to calculate the premium of Insurance Protection Schemes. The results show that, in addition to medical insurance for urban workers, funding level of other Social Security Plans are relatively low, social pool fund will bear great pressure, we suggest raising the amount of funding. In the group health insurance, to develop a competitive level of premium, we should fully understand parameters of the group, and the true level of past compensation, furthermore, develop effective adjustment factor of premium based on the past data of the compensation.The last part of this article is some summary and suggestion based on the research findings. The main contribution of this article:1.the author found that few people have studied the fees for outpatient care. Currently, Sichuan province is gradually implementing the program of outpatient co-ordination. Accurately measure the level of outpatient cost will be helpful to estimate funding of the outpatient co-ordinate and develop more comprehensive protection measures; 2.making use of three channels of data to systematically analyze the true level of medical expenditure and medical insurance loss in Sichuan province, further clarifying the costs of medical services and the growth rate of medical expenses; 3. this article simply calculate the premium of various insurance programs, and compare them with current level of funding, furthermore put forward some recommendations to improve the funding plan.Inadequacies of this article:1. Sichuan province is vast in territory and rich in natural resources, only three regions'data cannot precisely perform the whole level in Sichuan; 2. Type of diseases is an important factor of affecting medical expenses, however because of the lack of data and time, Research in this area is not involved; 3. There are many factors that affect health care cost, but this article doesn't use the method of multivariate analysis to analyze those factors.