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1.
Risk Manag Healthc Policy ; 16: 2783-2803, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-38145210

RESUMO

Purpose: To conduct a three-stage data envelopment analysis (DEA) of the operational efficiency of urban employee basic medical insurance (UEBMI) across 31 provinces in China from 2012 to 2021. Methods: Utilized a three-stage DEA model, this study measured and evaluated the operational efficiency of urban employee basic medical insurance within China's 31 provinces. Results: The operational efficiency of urban employee basic medical insurance in China was notably low, displaying significant disparities across different regions and periods. Substantial room for improvement exists. Environmental factors, including urbanization level and unemployment rate, wielded a pronounced influence on the operational efficiency of China's employee medical insurance. Conversely, the fiscal revenue and expenditure ratio hindered the enhancement of employee medical insurance efficiency. Conclusion: This study held valuable insights for enhancing the operational efficiency of China's urban employee basic medical insurance. To effectively improve insurance efficiency, the following recommendations are put forth: firstly, relevant departments should escalate resource investments and optimize resource utilization based on rational allocation; secondly, enhance legislation and regulations, fortify fund oversight, and ensure equitable and judicious utilization of the medical insurance fund; finally, leveraging modern high-tech advancements can comprehensively elevate the operational efficiency of the employee medical insurance fund. Ultimately, with the advent of cutting-edge technology, the operational efficiency of employee medical insurance fund can be comprehensively elevated.

2.
Int J Integr Care ; 23(2): 15, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37188056

RESUMO

Introduction: China is promoting integrated care. However, incomplete payment methods led to medical insurance overspending and intensified service fragmentation. Sanming implemented Integrated Medicare Payment Methods (IMPM) in October 2017, which integrates multi-level payment policies. Sanming's IMPM works well and has been promoted by the Chinese government. Therefore, in this paper, we aim to systematically analyze Sanming's IMPM, and conduct preliminary evaluations of Sanming's IMPM. Policy Description: IMPM integrates two levels of policy that are implemented simultaneously: (1) The payment policy for healthcare providers refers to how to calculate the global budget (GB) of the medical insurance fund paid to the healthcare providers and the policy guidance for the healthcare providers on how to use GB. (2) The payment policy for medical personnel refers to the adjustment of the evaluation index of the annual salary system (ASS) according to the IMPM's purpose and the payment policy that adjust pay levels based on performance. Discussion and lessons learned: After the IMPM reform, county hospitals (CHs) may reduce over-providing dispensable healthcare, and cooperation between hospitals may increase. The policy guidance (Determining GB according to population; Medical insurance balance can be used for doctors' salary, cooperation between hospitals, and promotion of residents' health; Adjusting ASS assessment indicators according to IMPM purposes) increases CHs' motivation to promote balances of medical insurance fund by cooperating with primary healthcare and increasing health promotion actions. Conclusion: As a model promoted by the Chinese government, the specific policies of Sanming's IMPM are better matched with policy goals, which may be more conducive to promoting medical and health service providers to pay more attention to cooperation among medical institutions and population health.

3.
Technol Health Care ; 31(3): 1077-1091, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36617803

RESUMO

BACKGROUND: To effectively monitor medical insurance funds in the era of big data, the study tries to construct an inpatient cost rationality judgement model by designing a virtuous cycle of inpatient cost supervision information system and exploring a complete set of inpatient cost supervision methods. OBJECTIVE: To lay the foundation for applying artificial intelligence (AI) technology in medical insurance cost control supervision and provide feasible paths and available tools for medical insurance cost control managers. METHODS: By way of collecting and cleaning electronic medical record (EMR) data from 2016 to 2018 of a city in East China, focusing on basic patient information and cost information, and using a combination of machine learning modeling and information system construction, the study tries to form a feasible inpatient cost supervision method and operation path. RESULTS: The set of the regulatory method, applied in nursing homes of a city in East China, is compelling. The accuracy rates of rationality judgement in different main diseases are stable up to 80%, the false positive rate is steady within 10%, and rehabilitation fee days of hospitalization, and the number of complications are important factors affecting the rationality of the inpatient cost. CONCLUSION: The model construction and optimization method combining machine learning and information system can make practical cost rationality judgement on medical institution's inpatient cost data, which can directly reflect the key influencing factors of relevant inpatient costs, and achieve the effect of guiding medical behavior and improving the efficiency of medical insurance fund use.


Assuntos
Inteligência Artificial , Pacientes Internados , Seguro Médico Ampliado , Humanos , Big Data , Registros Eletrônicos de Saúde , Hospitalização , Aprendizado de Máquina
4.
Artigo em Chinês | WPRIM (Pacífico Ocidental) | ID: wpr-995868

RESUMO

Objective:Clinical research is widely carried out in medical institutions, and there are differences in the use of research and conventional medical funds. This paper aimed to analyze the compliance issues of insurance fund in clinical research and explore the management strategies in the institutions conducting clinical trials or research.Methods:By consulting the literature, questionnaire, and work practice, this paper analyzed the current situation and existing problems of the compliance of the medical insurance fund in domestic clinical trials, proposed targeted management measures for the use of funds, and standardizes the corresponding workflow.Results:This paper summarized three payment methods of research-related funds and analyzed the main problems at present, including the definition of trial requirements, the payment of combined drugs specified in the protocol, the particularity of medical device trials, the payment of adverse events in clinical trial, the insurance of post-marketing research and clinical trial. According to the regulatory requirements and work practices, the corresponding management countermeasures were sorted out, including that the project funds and insurance audit should be carried out inside the medical institution. Clinical research, medical insurance management departments, ethics committees, and other departments should collaborate on establishing and improving a compliance management system. The research team should strengthen the management of adverse events, strengthen the publicity and education of the participants, and make good use of the sharing platform.Conclusions:The research institution should establish standardized and feasible processes, the research team should strengthen the management, and the use of the sharing platform is conducive to ensuring the compliance of the medical insurance fund and protecting the interests of the participants.

5.
Front Public Health ; 10: 988492, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36388392

RESUMO

Objective: The huge loss of health insurance funds has been a topic of concern around the world. This study aims to explore the network of moral hazard activities and the attribution mechanisms that lead to the loss of medical insurance funds. Methods: Data were derived from 314 typical cases of medical insurance moral hazards reported on Chinese government official websites. Social network analysis (SNA) was utilized to visualize the network structure of the moral hazard activities, and crisp-set qualitative comparative analysis (cs/QCA) was conducted to identify conditional configurations leading to funding loss in cases. Results: In the moral hazard activity network of medical insurance funds, more than 50% of immoral behaviors mainly occur in medical service institutions. Designated private hospitals (degree centrality = 33, closeness centrality = 0.851) and primary medical institutions (degree centrality = 30, closeness centrality = 0.857) are the main offenders that lead to the core problem of medical insurance fraud (degree centrality = 50, eigenvector centrality = 1). Designated public hospitals (degree centrality = 27, closeness centrality = 0.865) are main contributor to another important problem that illegal medical charges (degree centrality = 26, closeness centrality = 0.593). Non-medical insurance items swap medical insurance items (degree centrality = 28), forged medical records (degree centrality = 25), false hospitalization (degree centrality = 24), and overtreatment (degree centrality = 23) are important immoral nodes. According to the results of cs/QCA, low-economic pressure, low informatization, insufficient policy intervention, and organization such as public medical institutions, were the high-risk conditional configuration of opportunism; and high-economic pressure, insufficient policy intervention, and organizations, such as public medical institutions and high violation rates, were the high-risk conditional configuration of risky adventurism (solution coverage = 31.03%, solution consistency = 90%). Conclusion: There are various types of moral hazard activities in medical insurance, which constitute a complex network of behaviors. Most moral hazard activities happen in medical institutions. Opportunism lack of regulatory technology and risky adventurism with economic pressure are two types causing high loss of funds, and the cases of high loss mainly occur before the government implemented intervention. The government should strengthen the regulatory intervention and improve the level of informatization for monitoring the moral hazard of medical insurance funds, especially in areas with low economic development and high incident rates, and focus on monitoring the behaviors of major medical services providers.


Assuntos
Administração Financeira , Princípios Morais , Seguro Saúde , China
6.
Int J Equity Health ; 21(1): 93, 2022 07 11.
Artigo em Inglês | MEDLINE | ID: mdl-35820951

RESUMO

BACKGROUND: The security of medical insurance fund is very important to health equity. In China, the expenditure of medical insurance fund has increased sharply year after year, and the balance of local medical insurance fund is difficult to sustain. To realize the equitable distribution of the medical insurance burden, the central government has to continuously increase transfer payments, which causes regional unfairness in the distribution of central financial resources. This paper explores the influence of central transfer payments on the balance of medical insurance fund, influential mechanisms, and the strategic behavior of local governments. METHODS: First, we constructed a dynamic game model between central government and local governments and analyzed the mechanism of central transfer payments affecting the balance of local medical insurance fund. Then, based on the provincial panel data of 28 provincial administrative regions in China from 2004 to 2014, an empirical test was made. The spatial regression model was constructed, and the transfer payments obtained by neighboring provinces in the previous year were taken as instrumental variables. RESULTS: Central transfer payments led to strategic behaviors by local governments that resulted in increased local health insurance fund expenditures and lower balance rates. Moreover, the central transfer payments demonstrated "path dependence". Central transfer payments had a significant negative influence on the local NCMS fund balance rate. The local government subsidy and per capita GDP had a significant positive impact on the local NCMS fund balance rate. The obtained transfer payments of local governments had a significant space correlation. This study based on NCMS data remains valid. CONCLUSIONS: Central transfer payments induced the strategic behavior of local governments, which neglected to supervise the expenditure of medical insurance fund, reducing the efficiency of medical insurance fund management and use. The financial resources of medical insurance fund are unevenly distributed among provinces. Measures such as strengthening the supervision ability and initiatives of local governments, refining the central transfer payment mechanism, promoting the economic growth of western regions, and increasing rates for individual contributions appropriately can ensure that the medical insurance fund are used well and distributed equitably.


Assuntos
Financiamento Governamental , Seguro Saúde , China , Gastos em Saúde , Humanos , Governo Local
7.
Artigo em Chinês | WPRIM (Pacífico Ocidental) | ID: wpr-995981

RESUMO

As suggested by regulatory feedbacks from relevant national regulatory agencies on the use of medical insurance funds, noticeable problems were found in the compliance and rationality of medical service charges among Chinese hospitals. Based on the practice of hospital management, the authors summarized common problems of various medical service charge management as reported by the management authorities at all levels. These problems referred to name-replaceable charges and affiliated charges, splitting charges, repeated charges, and multiple(false) charges. On this basis, the paper analyzed such hospital management risks incurred as regulatory penalties, fee disputes and medical disputes, as well as their internal and external causes. In the end, the paper put forward countermeasures and suggestions for reference by hospitals in their management of medical service charges.

8.
Artigo em Chinês | WPRIM (Pacífico Ocidental) | ID: wpr-934571

RESUMO

Objective:To construct and verify a model of excessive medical behavior clues enrichment, for the technical support for the safe and rational use of medical insurance fund.Methods:A model of excessive medical behavior clues enrichment was constructed by the rank assignment method. The inpatient transaction records of medical insurance for employees and residents in 5 tumor hospitals in Beijing from 2016 to 2019 were obtained to verify the validity of the model. The patients were grouped according to age and gender, and each transaction record was converted into a standardized score V(0-100 scores), all transactions were divided into 22 groups according to V value. The Cochran-Armitage trend test was used to analyze the variation trend of enrichment rate with the increase of V value. Chi-square test was used to compare the chargeback rates of different groups. The correlation between the standardized score V and the amount of chargeback was tested by Pearson.Results:There were 872 599 and 86 356 hospitalization transactions for employee and resident medical insurance patients, with included 1 164 and 103 chargeback records respectively. The average score and median of V-value of employee and resident medical insurance transactions were scores of 49 and 50 respectively.When V>0, the enrichment rates of the employee and resident medical insurance were on the rise with the increasing of V( Z=23.86, P<0.001; Z=11.02, P<0.001), the refusal rates among different groups was significant different( χ2=1 307.16, P<0.001)and the correlation between V value and the chargeback amount was statistically significant( r=0.29, P<0.001; r=0.30, P=0.003). Conclusions:This study established a clue enrichment model of excessive medical behavior based on the rank assignment method. By analyzing a large number of medical insurance transaction records, the model can focus on the medical insurance transaction with suspected excessive medical treatment behavior, and has a certain guiding role in the management of medical insurance fund.

9.
Artigo em Chinês | WPRIM (Pacífico Ocidental) | ID: wpr-934570

RESUMO

In recent years, the medical insurance coverage of China has been increased significantly, and the medical insurance policies have been launched continuously, so the traditional manual audit method is unable to support medical institutions to effectively supervise the medical insurance fund. In view of this situation, a tertiary hospital in Beijing had successfully built an intelligent medical insurance audit system for drugs, diagnosis and treatment projects under key supervision, realized the prior audit and in-process control of the illegal use of medical insurance funds, through the establishment of intelligent audit rules, the design of audit trigger points and the interception level of illegal medical orders, and the establishment of a pre-operational preparation system and continuous improvement mechanism. In March 2021, the hospital officially launched the system. After the application of the system, the amount and quantity of outpatient medical insurance refusal from April to September 2021 were 10 587 yuan and 72 respectively, which decreased by 79.21% and 77.50% compared with the same period in 2020. This system effectively improved the quality and efficiency of medical insurance fund supervision.

10.
Work ; 2021 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-34308921

RESUMO

Ahead of Print article withdrawn by publisher.

11.
China Pharmacy ; (12): 2097-2102, 2021.
Artigo em Chinês | WPRIM (Pacífico Ocidental) | ID: wpr-886745

RESUMO

OBJECTIVE:To construct a calculation method which can accurately reflect the medical insurance fund expenditure of intervention scheme for cross-year survival patients ,and to provide reference for the research of medical insurance budget impact analysis(BIA). METHODS :Based on survival data of cohort model ,taking the patients diagnosed in each cycle in each year as a cohort,the number of per capita survival cycle of cohort patients in each state in the study year was calculated ,i.e. the average survival time ;on this basis ,the total cost of patients in all cohorts in the study year was calculated according to the number of people in each cohort and the per capita cost each cycle in each state. Taking the intervention scheme of a cancer as an example , the calculation was carried out by the established algorithm ,and the calculation results were compared with the results of several common algorithms ;at the same time ,the application suggestions were put forward for the expansion of the constructed algorithm in special cases. RESULTS & CONCLUSIONS :Compared with the several common algorithms ,the calculation process of the constructed algorithm is more in line with the process of medical insurance fund expenditure related to drug intervention scheme in the real world ,and it can flexibly adapt to the calculation needs in a variety of special situations. This algorithm can more accurately calculate the medical insurance fund expenditure of a intervention scheme in a specific year ,and to a certain extent solve the problem of inaccurate prediction of medical insurance fund expenditure due to insufficient consideration of cross-year survival patients or simple and rough calculation process. It can provide a more accurate method choice for the research of medical insurance BIA in China.

12.
Artigo em Chinês | WPRIM (Pacífico Ocidental) | ID: wpr-912700

RESUMO

Objective:To evaluate the impact of the reform of the county medical community on the expenditure of medical insurance funds, and to provide references for maintaining the stability of the medical insurance fund and deepening the reform of the medical community.Methods:Medical insurance data of urban and rural residents in M County, Yunnan province from 2016 to 2019 were collected, and a discontinuous time series model was used to analyze the impact of county medical community reform on medical insurance fund expenditures.Results:Since the reform, the number of patients discharged from county-level hospitals has shown a downward trend, averaging a decrease of 25.996 people per month; yet increases have emerged with the average hospitalization expenditure, the average hospitalization overall fund expenditure, and the average outpatient overall fund expenditure, averaging a monthly increase of 90.931 yuan, 50.014 yuan and 1.528 yuan respectively. The average hospitalization expenditure, the average hospitalization overall fund expenditure, and the average outpatient overall fund expenditure of the township hospitals all showed an upward trend, averaging a monthly increase of 31.191 yuan, 38.678 yuan and 0.085 yuan respectively. The flow of external medical insurance funds of the medical community has shown a continuous upward trend, averaging a monthly increase of hospitalization fund expenditures of 33.005 yuan, and a monthly increase of outpatient overall fund expenditures of 4.896 yuan overall.Conclusions:The M County medical community should further strengthen the top-level design, explore the reform of medical insurance payment methods, improve the regional information platform, standardize the referral system, and strengthen supervision to deepen the construction of the medical community to ensure the sustainable operation of medical insurance funds.

13.
Int J Health Plann Manage ; 35(1): 152-161, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31270860

RESUMO

PURPOSE: The increasing intensification of population aging can affect the balance of social medical insurance funds, an issue that has aroused much research attention. Against this background, this paper studies the impact of population aging on the balance of medical insurance funds in China. FINDINGS: With the introduction of six intermediate variables, ie, economic level, dependency ratio of the elderly population, physical condition, medical demand, medical expenses, and medical resources, a structural equation model is constructed. Then, the relations among these variables are analyzed to explore how population aging affects the medical insurance fund balance. The direct impact of aging is found not to be significant. Physical condition, medical resources, and medical demand are intermediate variables that can affect the relationship. CONCLUSION: The results show that population aging does not have a significant impact on the balance of the medical insurance fund. However, China's aging trend suggests that the population aging level is very likely to continue to intensify in the future. Moreover, the proportion of revenue in the medical insurance fund is progressively declining, and population aging may threaten the balance between revenue and expenditure. Finally, based on the above analysis, several corresponding recommendations and future studies are proposed.


Assuntos
Financiamento da Assistência à Saúde , Seguro Saúde/economia , Dinâmica Populacional/estatística & dados numéricos , Idoso , China , Previsões , Gastos em Saúde/estatística & dados numéricos , Gastos em Saúde/tendências , Necessidades e Demandas de Serviços de Saúde/economia , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/tendências , Humanos , Seguro Saúde/estatística & dados numéricos , Seguro Saúde/tendências , Dinâmica Populacional/tendências
14.
China Pharmacy ; (12): 1094-1099, 2019.
Artigo em Chinês | WPRIM (Pacífico Ocidental) | ID: wpr-816996

RESUMO

OBJECTIVE: To evaluate the effects of ivabradine in the treatment of heart failure on medical insurance fund budget in China, and to provide support evidence of related economical evaluation for medical insurance department to solve the problem of reimbursement admission of the drug in hospital outpatient department and the establishment of drug list in hospital. METHODS: Excel decision tree model was used. Pharmacoeconomic analysis was conducted based on the data reported in domestic literatures over the years. Firstly, according to the prevalence rate of heart failure in China, the number of patients with heart failure was estimated, which accorded with NYHA cardiac function class Ⅱ-Ⅳ, systolic blood pressure dysfunction and ivabradine indication. Then the cost of ivabradine was estimated. Secondly, the total number of hospitalizations and the cost of hospitalization due to heart failure were estimated. Finally, the cost of ivabredine and the cost of treatment saved by avoiding re-hospitalization due to the use of ivabredine were considered comprehensively. Static budget impact analysis was conducted to evaluate the effects of the use of ivabredine on medical insurance fund budget. RESULTS: The prevalence rate of heart failure in China was raised to 1.3% in 2013. It was estimated that the number of heart failure patients between 35-75 years old in China could be about 8.51 million and total hospitalization times was about 4.32 million per year. The economic burden of hospitalization in heart failure patients was about 168.940 billion yuan in whole country. Since 18% of patients could be avoided re-hospitalization after treatment with ivabradine, the cost of hospitalization could be saved by about 30.410 billion yuan, while the total cost of taking ivabradine was about 17.525 billion yuan. Therefore, the use of ivabradine could save the hidden medical cost budget by about 12.886 billion yuan, which had obvious cost-effectiveness. Static budget impact analysis results showed that by 2019-2020, the expected proportion of patients with heart failure covered by ivabradine would increased to 8.70%, and the total consumption sum would reach about 1.797 billion yuan. The incremental cost savings ratio (ICSR) showed that the cost of hospitalization could be saved by about 11 951 yuan for each additional case of heart failure treated with ivabradine; there could be 5 711 yuan of balance by deducting drug cost 6 240 yuan of ivabradine. CONCLUSIONS: The cost savings of hospitalization treated by ivabradine is not only enough to offset the cost of ivabradine itself, but also has a premium effect. The drug is of certain economy for the treatment of heart failure in China.

15.
Chinese Health Economics ; (12): 35-38, 2018.
Artigo em Chinês | WPRIM (Pacífico Ocidental) | ID: wpr-703456

RESUMO

Objective:To estimate the medical compensation fees in medical insurance fund under different compensation schemes in Inner Mongolia,and to study the feasibility of financing in the integration process of basic medical insurance for urban and rural residents in Inner Mongolia Autonomous Region.Methods:Based on the method of ratio method,original difference GM (1,1) model,Delphi method and moving average,the medical compensation fees under different compensation schemes in Inner Mongolia in 2015 was calculated.Results:Ignoring the factors such as pay line and cap line,the total compensation for medical expenses under the five medical compensation schemes were 18.778 billion yuan,25.355 billion yuan,30.351 billion yuan,32.346 billion yuan and 46.04 billion yuan.Conclusion:Based on the measurement of medical compensation under different compensation schemes,it calculated the financing amount of the integration of medical insurance,analyzed the feasibility of the basic medical insurance financing in Inner Mongolia.In the treatment of growth factors,insurance factors and other indicators,the innovative use of a variety of methods combined approach,scientific and effective calculation of the growth factor and insurance factor,revised a part of the annual growth factor which had large growth,the insurance factor value was too high and other problem,in order to accurately assess the medical compensation.

16.
Chinese Health Economics ; (12): 24-26, 2018.
Artigo em Chinês | WPRIM (Pacífico Ocidental) | ID: wpr-703454

RESUMO

Objective:To explore the mechanism and influences of population aging on medical insurance expenditure in China and put forward the improvement strategy of medical insurance.Methods:It constructed the structural equation model based on some related indicators in 31 provinces and cities of China from 2005 to 2015.Results:The indirect effect of population aging on medical insurance fund was higher than the direct effect.Medical expenses had the most influence degree of medical insurance fund.There were action and reaction between per capita GDP and medical insurance fund,while the reaction was much stronger.Conclusion:The government should construct a multi-level mode of disease prevention and control,further increase the government fiscal subsidies for medical insurance,improve the care coverage,and improve the financing mechanisms to develop the sustainable operation of medical insurance fund in China.

17.
Chinese Health Economics ; (12): 48-50, 2018.
Artigo em Chinês | WPRIM (Pacífico Ocidental) | ID: wpr-703431

RESUMO

Objective:Analyzing reimbursement limits of National Basic Medical Insurance Drug List 2017.Methods:The kinds of reimbursement limits and characters of relative drugs inquantities,categories and indications were concluded through methods of induction and correlation.Results:903 drugs were limited in National Basic Medical Insurance Drug List 2017,involving categories of insurance,serviceable range of pooling funds,second-line use and indications.Conclusion:The reimbursement limits were normative,ensuring rational drug use and efficiency of medical insurance funds.

18.
Artigo em Chinês | WPRIM (Pacífico Ocidental) | ID: wpr-487233

RESUMO

Objective To study the impacts of medicine and pharmacy separation reform on medical insurance fund and medical care seeking behavior of such patients.Methods The insurance data of patients was collected from year 201 1 to year 2014 at the hospital of the author.The differences of hospitals' revenue from insurance,the use of insurance fund and medical care seeking behavior of patients,before and after the reform were analyzed.Results The results showed that the effect of medicine and pharmacy separation reform in achieving translation;the proportions of drug and per-patient drug expenses were reduced.However,the demand of insurance fund was increased,and the fund used in outpatients began to exceed that used in inpatients after the reform.Totally,the choices of outpatients on doctor's technical titles were influenced by the pricing,as more outpatients tended to choose the intermediate title doctors,and the proportion was increasing.The differences of the choices on the outpatient in superior departments were very small,while those in non-dominant departments were very big,the same as the total patients.Conclusion There are both advantages and disadvantages in impacts of the reform on medical insurance fund conducted in some hospital in Beijing.The advantages included that the hospitals'revenue was not decreased from insurance patients,the use of insurance on paying drugs were reduced by management of proper medication, and out-of-pocket burden of the insurance patients was reduced.Yet the disadvantages contained that because of cheaper drugs and favorable insurance policy on the reform,the outpatients preferred higher level hospitals to buy drugs only,and the reform might lead to the increase of the requirement of insurance fund.

19.
Artigo em Chinês | WPRIM (Pacífico Ocidental) | ID: wpr-490789

RESUMO

Objective To learn the impact of county-level public hospital reform on the expenditure of medical insurance fund.Methods Using the difference-in-differences model to analyze the differences incurred in both hospitalization expenditure and expenditure of the fund at two county-level public hospitals.Results The reform has reduced both the drug expenditure and examination expenses per hospitalization at such hospitals at 318.5 yuan and 410.2 yuan respectively,yet with an increase of treatment expenditure of 535.6 yuan per hospitalization.No significant growth rate was incurred by the reform to the medical insurance fund.A significant difference of both hospitalization expenditure of patients and the fund was found among patients covered by different medical insurance funds.Conclusions The reform has achieved initial success at such hospitals in reducing inpatients′drug and examination expenditures.However,it is important to prevent from the treatment expenditure from an offset increase;to further reform the payment modes for safety of the fund,to remove the differentiation found in the existing medical insurance system,and leverage the regulating role of various medical insurance funds on medical service behaviors and expenditures.

20.
Artigo em Chinês | WPRIM (Pacífico Ocidental) | ID: wpr-401726

RESUMO

Objective To explore whether health examination save medical insurance fund or not. Methods To observe the sparing medical cost which 371 health examination people avoid repeated checking and shorten the length of stay during hospitalization from March 2006 to March 2007. To observe the effect of sparing medical cost because of regular health examination, early discovery diseases, pretreatment promptly and avoidance transforming to advanced diseases. Results Because of avoiding repeated checking and shortening the length of stay,everybody save the medical cost about 570 yuan,371 people can save about 21 ten thousands yuan. To statistics the average hospital cost of different courses of eight common diseases and malignant tumors from January to November at 2007, we discovered that the medical cost is large distinction between the earlier period and advanced stage of disease. For example: the medical cost of one stage of hypertension is 6608 yuan ,the two stage is 8838 yuan ,the three stage is 13 869 yuan, and the stage of hypertensive heart disease is 13 033 yuan. Parts of health examination crowd who stay at my hospital from 1996 were visited for five years ,we conformed many chronic diseases by prompt intervention can relieve and even reverse, avoiding the transformation to incurable disease which will consume a large number of strength and money. Conclusion Health examination resource is a medical treatment resource which isn't restricted by social security fund, the utilization can not only save medical cost but also discover and treat diseases earlier, thus we can save the strength and money before the advanced diseases.

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