The Challenge and the Coping Strategy of the Irrational Hospitalized According to the Medical Insurance Expense Management

Objective:To analyze the phenomenon of the irrational hospitalized,to discuss the coping strategy,and to control the increase of the medical expense rational. Method:This article combined the condition of patients who were enjoyed the medical insurance hospitalized with the management of the medical insurance,summarized and analyzed the phenomenon,the cause,and the result of the irrational hospitalized recent years in several hospitals,and explored the coping strategy and the normative management. Result:The people’s requirement according to the medical insurance was higher along with the civil medical insurance and the market economy. There were several irrational phenomena in the course of the hospitalized.For example doctor treated a minor illness as a serious disease,treated or examined a person who wasn’t ill. People was in hospital but wasn’t in the hospital,selected the expensive material and medicine,and so on. These phenomena influenced the quality of the medical insurance expense,and encouraged the excess medical treatment and the irrational increased of the medical expense. Conclusion:There are four steps aimed at the challenge what the irrational hospitalize caused to the medical insurance expense. Firstly to ascertain the medical and health system reform,secondly to perfect the medical insurance policy and strengthen to publicize the basic medical. Thirdly to promote the management of the medical insurance in the hospital. Fourthly to connect the medical insurance reform and the clinical pathway management,especially to control the amount of the basic medical insurance expense scientifically,to standard the medical,to control the increase of the medical expense reasonably,and to guarantee the safety of the insurance expense.