Study On The Medical Expenses Control Mechanism Of The New Rural Cooperative Medical System From The Perspective Of The Insured Person

The control of medical expenses goes hand in hand with the maintenance of the health right. The upward pressure of the growing medical expenses poses a challenge to the payment efficiency of medical fund. The medical expenses control has become an inevitable requirement of the sustainable development of the social medical insurance system. In medical expenses control, mechanism research shows us the interest relationship and the interest conflicts of the related subjects, and explores the mechanism’s action of medical expenses control, which is targeted to get rid of the obstacles of medical expenses control mechanism radically. Currently, the study of medical expenses control is mainly located in the field of disease treatment, and neglects the process and continuity between the disease prevention and the disease treatment, which is insufficient focus on disease prevention to the effect of medical expenses control. In disease treatment, the leading factor of patients’ selection that affecting the medical expenses is ignored completely. For this reason, this article selects the new rural cooperative medical system as the research object, tries to unify the disease prevention and the disease treatment of two processes from the perspective of the insured person, studying the mechanism problem of medical expenses control. First of all, this article has reviewed the history of rural cooperative medical system, and compared the condition of medical expenses control in different stages. From the comparative study of the medical expenses control, we get the the basic theoretical of the perspective of the insured person, and establish the analysis framework of trinity medical expenses control, beforehand, in-progress and afterwards. Secondly, according to the relationship among the subjects of medical expenses control, in the rural cooperative medical system history, the different types of medical expenses control are divided. On the basis of the internal mechanism of medical cost control, five types of medical expenses control are constructed, which are the profit constrainting type, the role orientating type, the organization dominanting type, the information balancing type and the interest coordinating type. Again, using the data of the rural residents’ interview, it shows us the medical expenses control mechanism from the perspective of the insured person. The mechanisms are divided into two types, the medical expensescontrol mechanism of disease prevention and and disease treatment. Both of the two kinds of medical expense control mechanism are facing pathway obstacle. The former is the disease preventiong pathway obstacle and the later is the disease treatment pathway obstacle. Moreover, improving the medical expenses control mechanism and constructing the circular pathways of the medical expenses control mechanism. This article chooses the structure adjustment and the content rationalization of the medical service demands as the orientation, and proposes mechanism optimization direction of the disease prevention medical expenses control and the disease treatment medical expenses control, the circular pathway of the disease prevention and the diease treatment. Finally, strengthening the capacity building of the insured ones, the medical institutions and the government, and putting forward the suggestions of medical expenses control. Balancing subalternation status of the insured person, the medical institutions and the government is brought forward. Enhancing the construction of autonomy capacity building of the insured person, the service capacity building of medical institutions and the basic public service capacity building of the government, which are feasible to medical expenses control.