The Supervisory Mechanism Research Of Public Hospital A’s Medical Insurance Financial

With a comprehensive coverage of China’s basic medical insurance, more andmore insured persons visit the designated institutions for treatment, but the problemsof its Medicare financial are becoming increasingly evident. In the Medicare systemmultiple principal-agent relationships exist in hospitals, insurance agencies andpatients. Due to the information asymmetry, the hospitals easily lead to the agent’smoral hazard problems, which have seriously affected the sustainability of the healthinsurance system. Hospitals as medical service providers are the main places where themedical expenses occur and play a vital role in the rational use of Medicare funds.However, we have not formed a supervisory mechanism. Therefore it is imperative toestablish a mechanism to implement the supervision and control of the hospital’sMedicare financial, and to guarantee the rational use of health insurance funds.This article firstly analyses the principal-agent relationship of Medicareinstitutions hospitals and patients, and explains the particularities of medical servicesand the medical insurance which are quasi-public goods and external effects. Thenclear the objective, principle and content of the hospitals’ Medicare financialsupervisory mechanism, and build a basic framework which consists of the governmentsupervision social supervision and internal oversight. Secondly, it analyses the currentsituation of hospital A’s Medicare financial supervisory mechanism. There are manyproblems as following: lack of an independent third party oversight body; ignoring theimportance of the social supervision; existing settlement methods resulting in hospitalA’s negative providence of medical services and the lag of its health insurancefinancial supervision; the weakness of medical insurance financial analysis and controlwithin hospital A and so on.Finally, on the base of the framework, some systems are designed to address thoseproblems of hospital A, for example, establishing a multi-level bodies of supervision,the trial implementation of DRGs PPS for the three first class public hospitals,establishing mandatory information disclosure system, the improvement of its internalcontrol system of health insurance financial.