Analysis of settlement expenses of basic medical insurance and their flow directions among different kinds of medical institutions / 中华医院管理杂志

ABSTRACT

ObjectiveTo find out about changes in expenses and the orientation of the insured to medical services and analyze the causes of expense growth and the result of containment so as to offer suggestions for policy formulation. MethodsA statistical analysis was made of the actual data on the medical insurance of retired and working personnel in Nantong City from 2000 through 2002 using SPSS and Excel. Results①The mode of payment via "plate" management and total quantity and mean value control resulted in fairly good expense containment, especially outpatient expense containment while the growth of hospitalization expenses was on the rise. ②Third-tier hospitals were most popular to people seeking hospitalized services while for outpatient services people were increasingly turning to clinics and designated drugstores where the average expenses per visit were low. Conclusion①The managing party of medical insurance should step up research on expense containment strategies, steer the patients towards rational splitflow, try to contain expenses in a scientific way, and improve the efficiency of fund utilization. ②Medical institutions confronted with opportunities and crises should enhance quality construction and deliver standard and reliable services. ③It is imperative to strengthen regional health planning and raise the efficiency of health resources utilization.