| The construction of China's social medical insurance system began with the "Labor Insurance Regulations of the People's Republic of China" promulgated by the Central Government in 1951.After more than 50 years of development,the social medical insurance system has basically achieved full coverage nationwide.According to the latest data released by the National Health and Family Planning Commission,the number of people participating in basic medical insurance has exceeded 1.35 billion.The social medical insurance system has become the most direct and effective institutional system to alleviate the medical burden of the people and protect the health of the people.Since the implementation of the social medical insurance system in Z City,the degree of protection and coverage of insurance have increased year by year.At present,a multi-grade security system including urban workers,urban residents and new rural cooperatives has been established,and basic medical insurance and major medical insurance have been established.In addition to the multi-level security system for supplementary medical insurance,in 2017,the number of people participating in urban basic medical insurance in Z City reached 647,000,the number of rural cooperative medical care reached 2.644 million,and the coverage of insurance coverage was over 95%.As a safeguard policy that benefits the people's livelihood,the social medical insurance system adopts the method of personal payment plus government subsidy in the fundraising process.The personal payment component only accounts for a small proportion of the social medical insurance financing,which is mainly for the insured group to be hospitalized.The medical expenses are reimbursed in proportion.In recent years,the continuous increase in the cost of hospitalization has led to an increase in the expenditure of social medical insurance funds,which has caused huge economic burdens for the sick people,and also brought certain stability to the stable operation of the Z-city social medical insurance fund.pressure.According to the 2017 China Health and Family Planning Statistical Yearbook,the per capita medical expenses for hospitalization in China reached 8828.1 yuan,a significant increase from the previous year.The total increase of inpatient medical expenses in the two consecutive years of social care insurance in Z City in 2015 and 2016 was more than 10%.In addition to the increase in expenses caused by inflation and medical expenses,there are medical providers and patients.The impact of the visit.Since the participants of social medical insurance are composed of the government,medical institutions and policyholders,and the medical services have strong professional barriers,the patients are in an information asymmetry in the process of seeking medical care,and the medical service users are likely to bear More medical expenses;at the same time,patients generally do not have a clear understanding of medical institutions,and will show some blindness in the course of treatment,which will lead to an increase in hospitalization costs.In order to properly control medical expenses and improve the basic health protection for the masses,China has continuously explored the reform plan of the medical insurance system since 1994.With the continuous reform and improvement of the social medical insurance system,its guarantee level and guarantee effect have been obvious.Improvement,but due to the large differences in social factors such as the economic system and the medical insurance system in various regions,the effects are significantly different in the implementation of the policy.In the context of increasing hospitalization expenses year by year,Z City raised the personal financing standard for social medical insurance in 2017,but the operation of social medical insurance fund is still under great pressure.The Z-city social medical insurance system is facing a large and stable development.problem.In summary,the analysis of the factors that have a greater impact on the hospitalization medical expenses of the Z-city social medical insurance participating groups and points out the possible unreasonable growth points behind it.Taking appropriate measures to control is the development of Z-city social medical insurance.Problems to be solved.This paper first introduces the development of China's social medical insurance system and the theoretical basis of cost control.At the same time,it studies the social medical insurance coverage of Z city,and points out the problems existing in the development of social medical insurance in Z city.Next,combined with the research of previous scholars,the basic characteristics of hospitalization expenses were analyzed and summarized.The expenditures of hospitalization medical expenses and medical service utilization of social health insurance participation groups in Z city in 2017 were counted,and the expenses of insured groups during hospitalization were obtained.The basic characteristics of expenditure and treatment behavior,and through the empirical analysis method,the factors that have great influence on the hospitalization expenses of Z city are obtained.On this basis,the possible unreasonable expenditures are analyzed,and the patients are found in the hospitalization process.The length of hospital stay is too long,and the distribution of medical service resources is uneven.Then,according to the ideas of payment by disease group(DRGs)and bed-to-bed payment in the reform of payment methods currently being implemented in China,the paper puts forward targeted control measures for the unreasonable expenses of hospitalization expenses in Z city,and finally based on the full-text analysis process.The problems found are discussed in the development of social medical insurance in Z City,and feasible ideas for good and stable development are proposed.This article is divided into six parts,the main content and views are as follows:The first chapter is an introduction.Firstly,it introduces the background and significance of the topic.In recent years,the cost of hospitalization expenses in Z City has increased year by year,which has brought great pressure on the operation of social medical insurance and the economic expenses of inpatients.The social medical insurance is in the process of operation and operation.Government subsidies account for a large proportion.Therefore,it is important for the development of social medical insurance to find out the factors that have a greater impact on hospitalization expenses and to find appropriate cost control measures for the unreasonable growth points that may exist.Then,combined with domestic and foreign literatures,the current research on the related factors of medical expenses and cost control is described.The research idea of this paper is problem-oriented.In view of the problem that the current inpatient medical expenses increase too much,which leads to the pressure of medical insurance fund expenditure,it is important to find out the unreasonable growth factors of hospitalization expenses and put forward reasonable control measures for the development of Z city social medical insurance.significance.In the research method,literature analysis method,empirical analysis method and comparative analysis method were used to conduct a comprehensive study on the cost control and development path of social medical insurance in Z city.The second chapter analyzes the theory of social medical insurance and the social medical insurance guarantee of Z city.Firstly,it introduces the basic situation of social medical insurance,and combines national,provincial and municipal statistical yearbooks to discuss in depth the development of social medical insurance and medical expenditure in China in the past ten years.With the development of social economy,social medical insurance The degree of protection and coverage have increased year by year.China's social medical insurance system has played a big role in improving the health of the people and effectively protecting the basic interests of the masses.However,the fund's revenue and expenditure have been under certain pressure.Then it analyzes the significance of social medical insurance cost control and the difficulties that may be encountered in the control process.Since the medical insurance participants include medical service organizations,and medical services usually have strong professional barriers,patients are using medical services.The process is prone to information asymmetry;social medical insurance is fair in the whole.If the government does not intervene to intervene,the market may be out of order,resulting in uneven distribution of medical resources and services,thus affecting some people.The immediate interests.Next,it introduces the security level and security system of Z city social medical insurance,and points out the difficulties encountered by Z City in the development of social medical insurance system in recent years.The third chapter analyzes the basic situation of the hospitalization expenses of the social medical insurance participating groups in Z city.Social medical insurance is mainly based on the cost of hospitalization for insured patients.Therefore,analyzing the overall situation of hospitalization expenses can help to understand the characteristics of social medical insurance expenditure in Z city,explore the influencing factors in the following and seek reasonable cost control measures.The presentation is of great significance.This chapter first analyzes the distribution characteristics of hospitalization medical expenses,and elaborates on the hospitalization expenses data of Z city social medical insurance group.Then it deals with the expenses of social medical insurance for different genders,different age groups and different disease types.Descriptive statistics show that different characteristics of hospitalized patients and the level of protection will have a certain impact on hospitalization expenses.Finally,the utilization of medical services by different patients is analyzed,and the ideas for the empirical analysis of the factors affecting hospitalization expenses are provided.The fourth chapter conducts empirical analysis on the influencing factors of hospitalization expenses,and draws the types of factors that have a greater impact on hospitalization expenses.The model selection and empirical analysis process in this chapter are based on the characteristics of medical expenses loss.Most of the medical expenses loss is concentrated in the low part,and the high part of the medical cost loss is less.It is similar to the Gamma distribution in the distribution pattern,so consider choosing GLM.The model empirically analyzes the influencing factors of hospitalization expenses.Next,the model is briefly introduced,and the functions of the parameter estimation method and the significance test are explained.The explanatory variables are determined by the analysis in Chapter 3.Through empirical analysis,it is found that the patient's level of protection,age,gender and other factors will have an impact on medical expenses,but the most influential part is the length of hospital stay,the type of disease and the level of medical institutions,which provides a reasonable cost control plan.in accordance with.The fifth chapter discusses the ideas and countermeasures of Z city to control social medical insurance expenses.Through the empirical analysis in Chapter 4,it is concluded that the cost of hospitalization is greatly affected by the number of hospital stays,the type of disease and the level of medical institutions.The main participants of social medical insurance are government agencies,medical institutions and insured groups.The provision of medical services in medical institutions and the choice of medical care for the insured groups will largely result in changes in inpatient medical services,identify unreasonable growth points,and take appropriate measures to restrict the behavior of the insured parties.The control of costs and the development of social health insurance are of great significance.The reform of medical payment methods is an important means of current medical and health system reform and social medical insurance cost control,and this policy is still in the process of exploration and implementation.Currently,Z City has not officially implemented this policy,so the payment was combined during the discussion.The idea of mode reform,using the actual medical data of Z City,explored the feasibility of controlling the cost of social health insurance in Z city by case-based payment(DRGs)and bed-to-bed payment.Firstly,the distribution of hospitalization days was analyzed.It was found that a large proportion of patients stayed in hospital for too long,resulting in higher costs.Therefore,the idea of paying for bed-to-bed was proposed.Next,the cost of patients with the same disease was analyzed and found to be similar.The medical expenses of patients are very different,so the idea of paying by disease type is put forward.At the same time,the hospitalization and cost of patients with different flow directions are analyzed.The problem of unreasonable cost increase is proposed through reasonable guidance for the patient's medical treatment..The final chapter is conclusions and recommendations.It is one of the main contributions of this paper to summarize the full-text analysis and combine the empirical analysis and the problems found in the research process to discuss the development of medical insurance and the improvement of the Z-city social medical insurance system. |
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