Study On Medical Insurance Management Of Valuable Medical Consumables In Jiangsu Province

Objective Through researching valuable medical consumables and analyzing medical insurance management policy in the typical areas, we described the use and management status of valuable medical consumables, analyzed the influence of valuable medical consumables on the cost and disease burden of patient and explored the medical insurance reimbursement policy for valuable medical consumables, to provide a theoretical basis and practical guidance for continuous improvement of the social health insurance system.Method Through the Internet, government websites and other platforms to collect policy documents or management practices that related to valuable medical consumables, focus on collecting medical insurance management policy about valuable medical consumables, and synthetically analyze medical insurance management policies and systems of valuable medical consumables of 13 cities from Jiangsu Province.We selected one city of Jiangsu province as the empirical research samples and get the 2010-2012 total data of patients who using medical consumables from the central database of Medicare administration, and focus on analyzing the cost of patients who using valuable medical consumables priced at 500 yuan and above in 2010,total 27,782 cases.Using SPSS19.0 multivariate regression to analyze the factors affecting the hospital costs for patients with certain diseases, further analysis the impact of the cost of valuable medical consumables on hospital costs; using Monte Carlo simulation by crystal ball software to simulate the personal burdens for the medical consumables cost under different simulated patient Medicare reimbursement policies Results 1. Policy analysis showed that the reimbursement policies of valuable medical consumables from each area were different. It presented "fragmentation" phenomenon, and the management system was not refined enough. Department of medical insurance couldn’t actually participate in the price management of valuable medical consumables. The use of the valuable medical consumables lacked corresponding specification.2. From 2009 to 2011, the number of the insured workers using valuable medical consumables grew from 52915 to 90836, increasing by 71.66%. The total expenses of the consumables rose from 189517560 yuan to 316003471 yuan, increased by 66.74%. The expenses of the consumables paid by urban worker medical insurance fund rose from 370148100 yuan to 656074858 yuan, increasing by 77.25%. Individual out-of-pocket costs of the consumables rose from 185120186 yuan to 259846078 yuan, increasing by 40.37%. Consumables cost accounted for 9.7%,10.5% and 10.9% of the total medical expenses in each year, and the personal burden ratio of patients by using valuable medical consumables was 33.30%, 28.90% and 28.40%.3. Empirical research showed that the valuable medical consumables used mainly in senile group,70.6% of patients were 50 years old or higher, and major diseases like eye disease, orthopedic disease, malignant tumor, cardiovascular disease, and liver, bravery, pancreatic disease, etc. The main medical consumables were cardiovascular stents, open surgery anastomat/stitching instrument/closer system, orthopedic titanium plate/screw, artificial crystal, etc. More than 95% of the patients were concentrated in tertiary hospitals.4. The average hospitalization cost was 25935.09 yuan, and the average cost of valuable medical consumables was 8703.33 yuan. Sort by the mean of valuable medical consumables cost, cardiovascular disease was the highest (30947.10 yuan), followed by chest diseases (25726.09 yuan), neurosurgery disease (14804.85 yuan) and orthopedic disorders (12201.57 yuan). Overall,58% of patients the consumables costs account for less than 30% of hospitalization cost, but 18.55% of patients the consumables costs account for more than 50% of hospitalization cost. And cardiovascular disease was the highest (57.56%), followed by chest diseases (57.44%) and orthopedic disorders (46.54%). In 2010, the personal burden ratio of patients with several types of the disease such as ear, nose and throat diseases, Anorectal disease, hernia, eye disease were over 40%, meanwhile, the personal burden of breast surgical disease patients was as high as 59.67%.5. For the valuable medical consumables cost of patients with cancer chemotherapy, cataract, coronary heart disease or diabetes, the mean was always greater than the median, which suggests that most patients used more expensive medical consumables. The valuable medical consumables cost account for19.1% of hospitalization cost, for coronary heart disease the ratio was highest (40.9%). Multiple regression analysis showed that the cost of medical consumables was the factor affecting hospitalization expenses for diseases except for cancer chemotherapy, and the regression coefficient was greater than other factors, which indicates that the use of valuable medical consumables has a significant impact on hospital costs of patients again.6. Monte Carlo simulation showed that Medicare reimbursement policy for certain medical consumables exist room for adjustment. For vascular stents, the proportion paid by individuals first can be set at 10%, and the Medicare payment limit can be set at 30,000 yuan. For the titanium plate, the proportion paid by individuals first can be set at 10%, and the Medicare payment limit can be set at 5,000 yuan. For IOLs, the proportion paid by individuals first can be set at 10%, and the Medicare payment limit can be set at 1800 yuan.Conclusion With the population aging and the development of new materials science, valuable medical consumables changed each day and our health insurance fund face tremendous pressure on reimbursement. Optimizing management of valuable medical consumables needs multisectoral collaboration. On the one hand, beginning from the top-level design, we should progressively develop category management methods of valuable medical consumables, narrow the gap around the medical insurance policy and establish access system of valuable medical consumables. On the other hand, we should standardize the behavior of doctors, strictly implement clinical pathways and build medical insurance management system of valuable medical consumables.