Research on the Influence of the Outpatient Security Level’s improvement on Medical Service Utilization and Medical Insurance Fund Expenditure -Based on the case analysis of Sanming City

Corresponding author: Yang Fan, 632682623@qq.com

DOI: 10.12201/bmr.202107.00028

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  Abstract: Based on the monthly report data on the operation of public hospitals and the use of medical insurance funds published by Sanming Municipal Government, this paper analyzes the changes of the utilization of medical services and expenditure of medical insurance funds in Sanming City after the improvement of urban employees’ medical insurance outpatient protection level. The results of data analysis show that after the policy intervention, the outpatient demand of workers medical insurance insured groups in Sanming city was released; There has been a certain degree of substitution between the utilization of inpatient services and outpatient services in the insured groups; The construction of graded diagnosis and treatment order in the region is in good condition; There is no obvious change in the expenditure trend of the employee medical insurance pooling fund. Based on the above analysis results, this paper puts forward corresponding policy suggestions, including setting the proportion of outpatient reimbursement payment among different levels of medical institutions reasonably, improving the supporting policies such as outpatient doctors remuneration and drug supply, and connecting public health with outpatient security policies.

  Key words: Medical insurance for urban employees; Outpatient protection; Reimbursement ratio; Medical services; Medical insurance fund

  Submit time: 2 November 2021

  Copyright: The copyright holder for this preprint is the author/funder, who has granted biomedRxiv a license to display the preprint in perpetuity.
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