Study On Controlling Medical Expenses Rationally By Medicare Payment

The rapid growth of medical costs has become a global issue currently, third‐party payment of medical insurance is seen as an important measure of sharing public disease burden and regulating growth of medical costs for its economic leverage to medical services. But third‐party payment does not pay function independently to achieve policy objectives because its core content is about payment method, payment rates and payment scope. The mechanism of interest transmission and support institution are significant, and environment plays a key role. Controlling medical expenses reasonably is a systematic process.The research has summerized the progress of reform of medicare payment at home and abroad, and the core of national health insurance payment including payment method, payment range, payment standard, supporting condition of medicare payment and environmental conditions. Combined with characteristics and objective of medicare payment, that controlling medical costs reasonably is affected by multiple factors is determined.The research has extracted information of hospitalization expenses of different payments from HIS system of certain grade‐three general hospital in Beijing, and analyzed the data by Excel and Access software, to discover the impact of medicare payment policy and to try to refine factors of controlling medical expenses reasonably by medicare payment.Based on system science, the system model of controlling medical expenses resonably by payment has to be constructed. The core elements, support elements and system environment are included in the system. It refers to the core content of the coreelements that including payment method, payment range, payment standards. Price,negotiation, motivation, supervision and hospital management philosophy are included in support elements. Medical insurance system, medical service system, market mechanisms and government action,and information system are included in system environment. The interaction of system elements, and the impact of system environment play a significant role in controlling medical expenses reasonably by medicare payment.Based on above research, the study presents key strategies of controlling medical expenses reasonably by medicare payment:(1)Promote medical and health system to provide adaptive conditions.(2)Build stakeholder negotiation platform to facilitate timely adjustment of the core content of medicare payment.(3)Establish management concept associated with payment reform to improve initiative of hospital to control medical expenses reasonably.(4)Establish physician incentive system and play the main role of controlling costs of doctors under the guidance of medicare payment.