A Study On The Burden Of Individual Hospitalization In Shanghai Urban Employee 's Basic Medical Insurance System

Objective:The purpose of this study is to get information about hospitalization own expense of urban workers insured in basic medical insurance, to analyze the causes of own expense of the insured workers, to put forward suggestions for basic medical insurance and to decrease own expense for hospitalization.Method:Collecting the government documents about the basic medical insurance policy on the medicine, treatment, service scope and payment standard in recent years; investigating questionnaire of hospitalization expense and own expense in order to make a qualitative research; using single-factor and multiple-factor to analyze own expense of hospitalization medical; using focus group discussion method to research the own expense problems and suggestions by producing the workers from the medical insurance institution.Results:(1) The hospitalization own expense in shanghai is heavy; (2) medicine and surgical materials are the main items of own expense; (3) the problem of high hospitalization own expense is more serious for elder, patients with serious diseases, patients in Gradeâ…¢hospitals and low-income patients; (4) the hospitalization own expense is related to grade of hospital and diseases types, and it is not related to economic condition of the insured patient, which means the low-income patients have to bear the same pressure of hospitalization own expense; (5) the causes of heavy hospitalization own expense are complicated, and they include new technology, maximization of health care demands of insured patients, design of approved medicine and treatment lists related to basic medical insurance, medicare prospective payment system, behavior of medical service providers, supervision of own expense and problems of medical and public health system.Conclusions:In order to control the increasing hospitalization own expense and ease own expense pressure of the insured workers, it is necessary to reform the approved medicine and treatment list and medicare prospective payment system, create a government supported or managed commercial medical insurance system as supplement of basic medical insurance, establish a supervision system of own expense in medical care institutions, stop all the doctor-induced demands, improve compensation mechanism of public hospitals and make public hospitals really work for public benefit and serve patients better.