Research On The Control Of Social Medical Insurance Expenditure In China

Since1998the state council issued the decision on establishing the basic medical insurance system for urban employees, the medical insurance system reformation began to carry out, one of the focus of the reformation is to control the health insurance expenditure that continues its growth. The relevant subjects of the basic medical insurance have doctors, patients and insurers, the interests of different parts is difficult to balance, lead to medical costs unreasonable increase. Under the basic medical insurance system for urban employees,"expensive and difficulty of see a doctor" is serious problem. This thesis takes how to control the unreasonable growth of social medical insurance expenditure as the research object of study, through the medical service suppliers, medical service demand, the medical insurance agencies and government work together to control the unreasonable health insurance expenditure growth.This article, at the beginning, introduces the meanings and contents of social medical insurance expenditure control, analyzes these reasonable factors and unreasonable factors of health insurance expenditure growth. The reasonable factors include the growth of income, an aging population, the progress of medical technology and the change of the disease; the unreasonable factors include moral risk, payment and health systems. This paper adopts the way of combination of practice and theory and other methods, study the current status of the medical insurance in our country by consulting the literature, analyzing the present situation of social medical insurance expenditure control.On this basis, discusses the problem of the social medical insurance expenditure control of the four aspects:these factors that medical service suppliers lead to medical insurance expenditure increasing include the excessively rapid growth of hospitalization medical expenses, drug expenses account for the large proportion of medical expense, lacking of competition and exiting mechanism among designated medical agencies; the factors that medical service demanders lead to medical insurance expenditure increasing include medical service demanders’ behavior lack of constraints, the co-pays is unreasonable; the factors that medical insurance institution leads to medical insurance expenditure increasing include payment system is unreasonable, medical information system is not perfect, the supervision of medical insurance fund is not perfect; government financial input is insufficient in medical insurance expenses control etc. Then, experiences of the typical foreign medical insurance expenditure control models are summed up, in accordance with of China’s situation, learn foreign medical insurance cost-control measures. This paper put forwards a series of control measures for social medical insurance expenditure from four aspects including medical service suppliers, medical service demanders, medical insurance institution and government agencies. These cost-control measures for medical service supplier includes controlling the hospitalization medical expenses, strengthening the competition among designated medical agencies, perfecting the compensation mechanism of medical institutions, establishing credibility evaluation mechanism; these cost-control measures for medical service demanders includes establishing incentive policies, setting up different co-pays, improving the health consciousness; these cost-control measures for medical insurance institution includes establishing a scientific payment system, establishing the effective medical service information published mechanism, establishing medical insurance expense monitor system; these cost-control measures for government includes building harmonious relationships between doctors and patients, increasing government financial investment in the medical field etc.