Dissertation > Economic > Fiscal, monetary > Insurance > China's insurance industry > Various types of insurance

Research on the Third-party Medical Expenditure Control

Author ZhuJi
Tutor LiuYing
School Zhejiang University of Finance
Course Social Security
Keywords Public Medical Insurance Medical Expenses Control The Third-party’s Purchasing Mechanism Competitive Mechanism
CLC F842.6
Type Master's thesis
Year 2012
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Basic Medical Insurance System was established in 1998,it was marked the transforming from stage of public health care to Social health insurance. The New Type of Rural Cooperative Medical Care System which established in 2003 has covered over 90% rural residents;the Basic Medical Insurance System for Urban Residents which founded in 2007 has brought urban non-employed residents into the range of Social Medical Insurance. Thus far the three public medical insurances had included the majority of our populations.we will talk about this four questions in follow.Why does the amount of medical expenses increasing so rapid?We take an analysis of factors refers to the medical expenses growth and draw the following conclusions:first,economic growth these years drives the boosting of medical expenses and it is a kind of rigid growth;second,with the expanding of Social Medical Insurance’s coverage,the proportion of cash account in the medical expenses descends in the short-term while the total medical expenses is still in the circulation of rising and it is really a financial burden for the society;third,from the perspective of medical service supply,the amount of medical institution、hospital bed、medical care personnel is Increasing slowly.The situation of insufficient supply triggers the medical expenses growth. Insufficient financial medical health inputs causes the level of medical insurance is much lower than the world average level,and the reality of medical insurance disable to cover all the population make the inequality even worse. The three public medical insurances each operates independently,medical insurance fund’s pay level、capacity are total different. As the important sources of medical expenses,three public medical insurances’funds lead the existing medical price get rise under the situation of poor supervision. The consequence is the participants can’t attain the benefits. So far,the reform of public hospital now into the stage of critical period,if the compensation mechanism can’t make a fundamental change,the strong willing of control medical expenses is impossible under the applying of market mechanism.Why should we control the third-party medical expenses?The original intention of Social Medical Insurance is restrain the medical service supply by strengthening the third-party’s purchasing mechanism and compensate the medical insurances’funds for the enhancing the quality of service. And then the objective of improving the health of the residents’level could be reached. The medical market has its own characteristics and those characteristics keep the demander as an absolutely vulnerable position in the game. The medical insurance premium ,as the agent of participants who exercising the right provided by the third-party buyers and negotiating with medical service supplier. The core content of negotiation is medical service and its’price. Technically, the existence of the third-party medical expenses’control is the internal demand of Social Medical Insurance. The protection of citizens’ health is the country’s obligation.,the whole society should pay for the heavy medical expenses. The method of transferring medical expenses is not sustainable,and the medical expenses growth does not bring the good service quality and health level necessarily. All the documents about medical reform after 2009 are claiming for the sound third-party’s purchasing mechanism. The mission of controlling medical expenses is the significant destination of the medical insurance premium and it has realistic urgencies.Are there any ideas or experiences from third-party medical expenses control in foreign countries? The establishment of medical insurance institution is tending toward perfection overseas, no matter what social support institution adopts, introducing the third-party is current practice. Some competition theory of management also requests to adopt the third-party engagement in order to control the rising of medical cost. In America, the third-party purchasing mechanism is tending perfect, powerful purchasing body has already strongly restrained the medical services provider. In Germany, they make full use of medical expenses negotiation through the insurance of social Medicare fund legal person. In England, the government plays the role of third-party, by multi-purposed using of medical expenses payment method and strict referral system to control the rising. Although all the countries are trying to make some change about Medicare system, controlling the boost of medical expenses becomes one of the most important targets of reform.How dose our country manage the control of third-party medical expense? On the present stage, the Medicare organization buyers become stronger, nonetheless, the casualness of negotiation, deficiency of management restrains the negotiation means of the Medicare organization, so that the capacity of controlling seems to be weak, the third-party purchasing system is actually not founded. Controlling the third-party medical expenses firstly demand a good institution foundation. Secondly needs innovating the payment and perfect the supervision mechanism, strengthen Medicare negotiation system, to maximize the buyers’profit through many times game model. And thirdly to build the competition institution between Medicare organization when conditions permitting, enforcing the expenses controlling consciousness of third-party by the competition between Medical organizations. Lastly , we should enhance the information-based, control the expenses more scientifically by promoting informatization. We need to make a strong co-operative effort in controlling the boost of medical cost, as a third-party buyer, Medicare organization plays an irreplaceable role in controlling medical expenses.

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