Regulation Of Town Worker Outpatient Service Of Insurance Of Primary Medical Treatment Chronic Diseases Research

With the development of the society and economy, even the arrival of an aging population,the disease spectrum and the cause of death have been changed across the whole world. Heartdisease, care brovascular disease, diabetes, chronic diseases such malignant tumor have becomemain factors leading to death. At the same time, chronic diseases have become China’s majorpublic concern. With the advent of the era of universal health care, the basic medical insurancehas played an increasingly important role in reducing medical expenses burden by adjusting theprimary medical treatment.At the same time, the aging population and increase of the chronic patients have broughtheavy burden to the expenditure of health insurance fund. Medical insurance fund needssupervision. In addition, risk prevention mechanism needs to be perfected. In the context ofkeeping medical insurance fund moving to fill the medical demand, we need to curbunreasonable medical expenses, health insurance fraud to ensure the safety of fund.This essay will take town worker’s basic medical treatment insurance of chronic diseaseoutpatient supervision in Zibo as the research object. Through consulting and analysis thedocument of chronic disease management about the outpatient service of insurance, we can findout the reference model. Besides, through the analysis of the different stages of city outpatientchronic policy in Zibo, I have compared the effects of the policy implementation and theproblems that exist in medical insurance fund operation. On the one hand, I drew lessons fromthe UK, Germany and other developed cities such as Shanghai and Qingdao’s medical insuranceregulation in the outpatient management of chronic diseases. On the other hand, I also analyzedthe management of chronic disease treatment of our city; I finally came up with the measuresand suggestions of managing the town worker’s basic medical treatment insurance in Zibo basedon deduction and comparative analysis.Through the comparison of three stages’ policy about Medicare outpatient chronic and theanalysis of the characteristics of the outpatient service medical treatment in chronic diseases inZibo, the problems in the chronic disease outpatient medical insurance regulation have arisen.Such as: first, the characteristics of outpatient treatment with chronic diseases did not fit the insurance regulation; second, the methods that were used in the Chronic disease outpatientservice often led to low efficiency; third, Medical insurance regulatory works lag; fourth, thereare still many problems about the Fixed-point units’ behavior and subjective intent. The causes ofthese problems are as follows: First, little attention was paid to the outpatient management.Besides, the payment of chronic disease outpatient is not fit for the rational use of medicalinsurance fund. Moreover, the construction of the medical insurance information system is out ofdate. Furthermore, the implementation of the regulation is not enough. Finally, there areproblems about medical insurance training and lack of laws and regulations on insurance fraudproblems.Based on the analysis and research that mentioned above, I came up with the followingmeasures on the chronic disease outpatient medical insurance regulation in Zibo: Firstly, perfectthe laws and regulations of health insurance supervision and administration. Secondly, createindependent medical insurance regulators, and straighten out the supervision mechanism. Thirdly,pay attention to the cumulative effect of chronic disease, and delay the cover range of the chronicdisease outpatient service medical treatment insurance. Fourthly, improve the structure ofoutpatient chronic diseases and the method of payment. Fifthly, improve the information networkconstruction, and establish an early warning system for the chronic disease outpatient expenses.Sixthly, set up VIP talk-about and follow-up mechanism. Seventhly, expand the scope of themedical insurance training. Eighthly, introduce the negotiation mechanism, and buy outpatientdrugs in groups. Ninthly, explore the integration of medical service and medical insurance. Lastbut no the least, establish and perfect the information disclosure system, and intensify socialsupervision.