Analysis of Drug Medical Insurance Access Pricing Based on the Perspective of Binary Equilibrium

Objective To study the influencing factors in the process of national medical insurance negotiation and drug pricing from the dualistic equilibrium perspective,and to provide reference for the harmonious management of drug pricing in China.Methods Through the literature analysis and policy review,the pricing subject,pricing basis and price control system in the pricing process of medical-accessed medicines were analyzed from the perspective of binary equilibrium and harmonious management.Results and Conclusion It is found that four balances in the drug pricing process,two balances in pricing basis and three balances in price control system need to be considered,respectively.Drug pricing is the key content of national medical insurance access,which is also the hotspot of the policy in the pharmaceutical fields in recent years.Drug pricing not only reflects the value of drugs,but also reflects a lot of top-level designs of binary equilibriums in medical insurance policy.While the rational design of drug pricing requires the joint efforts of the government,pharmaceutical companies and relevant experts to comprehensively consider many equilibriums,so as to improve the relevant systems.

Inspiration of Foreign Innovative Drug Pricing Methods and Medical Insurance Payment Standards to China

Objective To study the innovative drug pricing methods and medical insurance payment standards in foreign countries and to provide reference for China’s government.Methods The official websites were searched for information and related literature,and literature review was used.Results and Conclusion In foreign countries,the clinical value of innovative drugs and their impact on medical insurance funds were comprehensively evaluated based on factors such as quality-adjusted life years,clinical benefit,and improvement of clinical benefit.Then,the evaluation results were taken as an important basis for whether innovative drugs were admitted to the medical insurance catalog and establishing medical insurance payment standards.By using international experience for reference,innovative drug pricing methods and medical insurance payment standards for China’s national conditions can be improved by establishing a basic database of clinical value and drug economic evaluation of innovative drugs,as well as innovative drug payment models based on decision thresholds.

The Impact of Population Aging on the Expenditure of Medical Insurance Fund for Urban Workers in China

Objective To explore the impact of population aging on the expenditures of medical insurance funds against the background that great changes in population structure influences economic development.Methods Through analyzing the impact of the population aging,the income and accumulated balance of the medical insurance fund,and other related factors on the expenditure of the medical insurance fund,development status of the medical insurance fund for urban employees in China since 2003 was obtained.Stata 16.0 was used to perform multiple linear regression analysis on related factors to determine the correlation between population aging and the change in medical insurance expenditures.Results and Conclusion The factors that have a greater impact on the expenditure of the medical insurance fund are the amount of income from the medical insurance,followed by the number of people over the age of 65 in China and the urban retired employees participating in medical insurance.We should focus on the sustainable development of the urban employee medical insurance fund to deal with the threat of aging.

Comparative Study on the Development of Urban Basic Medical Insurance in 14 Cities of Liaoning Province

Objective To put forward some suggestions for the development of urban basic medical insurance of Liaoning by comparing the development situations in 14 cities of Liaoning Province.Methods Relevant data of urban basic medical insurance from 2008 to 2018 in 14 cities were collected to make a comparative analysis,and the 5 why analysis chart was drawn to investigate the development differences in 14 cities.Results and Conclusion The average growth rate of the number of urban residents covered by urban basic medical insurance varied greatly from 2014 to 2018.The range of average growth rate of urban residents’medical insurance is 19.1%,and the range of average growth rate of urban workers’medical insurance is 9.1%.Funding standards are basically the same.It is suggested each municipal government should attach importance to this issue.They can make full use of information technology to coordinate with various authorities and ensure the smooth development of medical insurance.Besides,they must actively adapt to their conditions to better develop the urban basic medical insurance of Liaoning.

An Ensemble Methods for Medical Insurance Costs Prediction Task

The paper reports three new ensembles of supervised learning predictors for managing medical insurance costs.The open dataset is used for data analysis methods development.The usage of artificial intelligence in the management of financial risks will facilitate economic wear time and money and protect patients’health.Machine learning is associated withmany expectations,but its quality is determined by choosing a good algorithm and the proper steps to plan,develop,and implement the model.The paper aims to develop three new ensembles for individual insurance costs prediction to provide high prediction accuracy.Pierson coefficient and Boruta algorithm are used for feature selection.The boosting,stacking,and bagging ensembles are built.A comparison with existing machine learning algorithms is given.Boosting modes based on regression tree and stochastic gradient descent is built.Bagged CART and Random Forest algorithms are proposed.The boosting and stacking ensembles shown better accuracy than bagging.The tuning parameters for boosting do not allow to decrease the RMSE too.So,bagging shows its weakness in generalizing the prediction.The stacking is developed using K Nearest Neighbors(KNN),Support Vector Machine(SVM),Regression Tree,Linear Regression,Stochastic Gradient Boosting.The random forest(RF)algorithm is used to combine the predictions.One hundred trees are built forRF.RootMean Square Error(RMSE)has lifted the to 3173.213 in comparison with other predictors.The quality of the developed ensemble for RootMean Squared Error metric is 1.47 better than for the best weak predictor(SVR).

Analysis of inpatient payments of breast cancer patients with different medical insurance coverages in China(mainland) in 2011–2015

Objective： An understanding of the levels and trends of medical cost is made for breast cancer patients with different medical insurance coverages in China（mainland）, in an attempt to offer a clue to further control the costs.Methods： The inpatient payments of 9,716,180 breast cancer patients spent in medical institutions of different types and grades during 2011–2015 were collected from the inpatient medical record home page（IMRHP） dataset.The data were then processed with SAS（Version 9.3; SAS Institute, Cary, NC, USA）. Indicators like means,increase（decrease） percentages were used to descriptively analyze the average hospitalization expense of each time（AHEET） and its trends of breast cancer patients with different medical insurance coverages treated in medical institutions of different types and grades.Results：In 2011–2015,the AHEET borne by breast cancer patients in China had been constantly increasing.Specifically,the self-pay inpatients had the largest increase,inpatients covered by Urban Employee Basic Medical Insurance（UEBMI）and Urban Resident Basic Medical Insurance（URBMI）were the next,and those covered by New Rural Cooperative Medical System（NRCMS）had the least increase.Breast cancer inpatient treated in public hospitals had quite greater increase and higher expenditure level than those in private hospitals.The AHEET borne by the inpatients in Grade 3 hospitals had greater increase and higher cost than those in Grade 2 hospitals.Conclusions：The inpatient payments of breast cancer patients will be wisely controlled by reducing the number of self-pay inpatients,taking advantage of restriction mechanism of the medical insurances,and promoting healthy competition between private hospitals and public hospitals.The economic burden imposed on the society by breast cancer can be relieved through further control of inpatient payments of UEBMI-and URBMI-covered breast cancer patients and of Grade 3 hospitals.

Software Process Modeling with UML in Development of Medical Insurance MIS

This paper describes how to use the Unified Modeling Language (UML) to modeling software processes in medical insurance MIS, and compares UML Modeling method with classic PO(Process Oriented) Modeling method. It indicates that the whole performance of application system model described by UML is much better than the one described by PO.

Analysis of the effect of medical insurance on cancer inpatients: A 10-year retrospective study on a large hospital in Northeast China

Objective The aim of the study was to analyze hospital costs for cancer inpatients availing different methods of payment and the influencing factors, to provide inputs to improve the medical insurance payment policy. Methods We analyzed the information related to length of hospital stay, hospitalization cost, and self-pay cost, collected from one large-scale, Grade A, Class Three hospital in Shenyang, China, during 2004–2013.Results The number of cancer inpatients with different payment types(medical insurance group and non-medical insurance group) presented a rising trend. Further, the ratio of medical insurance inpatients increased rapidly(from 22.2% to 48.7%); however, this group was still a minority. The length of hospital stay became shorter(21 d vs. 17 d; P = 0.000) while the gap got narrower; the hospitalized expense showed an upward trend and the difference was remarkable($24048.6 ± $4376.28 vs. $20544.36 ± $4057.01; P = 0.000). Conclusion Along with normalization of cancer therapy, the influence of payment on treatment has been getting weak, the policy has impact on controlling hospitalization cost, lightening burden of cancer patient, as well as allocating medical resources in a reasonable way, becoming an important defray pattern of hospitalization cost.

A Study of Medical Insurance With Big Data in Taiwan

The structures of numerous industries, including the insurance industry, have been altered by the ongoing development of associated technologies. As the insurance industry undergoes this period of technology transformation, it is important to recognize the key role that big data play in the industry. Most critically, the industry could not function without the utilization of big data, which explains to a large extent why every insurance company maintains its own numeric database. Relatedly, Taiwan＇s Bureau of National Health Insurance recently established the Information Integration Application Service Center, to which qualified companies and institutions can submit applications for permission to analyze the bureau＇s collected disease data according to stipulated regulations. In effect, access to the center＇s data provides insurance companies with a further means of improving their operational effectiveness through the analysis of big data, with targets for potential improvements including the various strategies utilized to react to changes in the environment, such as those involved in marketing, administrative management, and product pricing and services. The foundation of the present study consisted of a literature review and survey, with the key objective being to determine and discuss the effects of big data analysis on the medical insurance industry, including the changes that the utilization of big data results in for the customers of medical insurance companies. With the issues discussed above in mind, the survey was designed to determine whether medical insurance consumers know about and understand the effects of big data. The survey data indicated the following key findings： （1） The two concepts exhibit clear differences in terms of population statistic wxiables; （2） The two concepts exhibit clear differences in terms of insurance purchasing variables; and （3） The two concepts exhibit clear differences in terms of the level of understanding regarding big data.

The Initial Exploration of The Catastrophic Medical Insurance in Shanghai

Developing the catastrophic medical insurance for urban and rural residents positively is the key action to keep the new round of reform for medical system into deep. However this insurance is the ＇shortage＇ of the national health system, so the Shanghai government carries out The Trial Measures for Catastrophic Medical Insurance of urban and rural residents in 2014. In this thesis, we will describe the current situation of the catastrophic medical insurance in Shanghai from aspects of financing, level of compensation, the way to undertake and regulatory. What＇s more, we expect to explore the weakness of catastrophic medical insurance in actual motion, and offer proposals for progressively realizing the integration of urban and rural in medical insurance, improving the basic health care directory, enhancing cooperation with commercial medical insurance.

Literature review of the basic medical insurance of urban and rural integration

To set up the nation＇s covering medical insurance syslem and to the realization of the basic medical insurance of urban and rural integration, is the inevitable trend in the development of China＇s medical insurance reform, as well as it is also a key step. In recent years, the state promulgated a series of policies in promoting urban and rural medical insurance and many cities took the lead to reform form the medical insurance pattern with local characteristics. All of these are helpful for our country to realize the integration and providing valuable experience. The target of the article is to maintain the public cause of medical and health, to solve the problem of high cost of urban and rural residents to see a doctor. As well as to realize the objections of disease pro^ection, convenience, cure spends less.

The study of basic medical insurance system for urban residents in China

The basic medical insurance system for urban residents is an important part of China＇s social security system.This article analyzes the problems which existing in the basic medical insurance system for urban residents and puts forward the corresponding countermeasures.

Research on Risk Control of Medical Insurance Fund

Social health insurance is an important part of the social security system. It is the ＂stabilizer＂ of social and economic development and the ＂buffer＂ of reform. It is of great significance and function to the construction of economic development, social progrcss and harmonious society. However, due to many factors, the operation of the social health insurance fund is facing greater risk. Although the balance is rich, but the general talk about the ＂balance＂, inevitably fall into the ＂too optimistic, ignore the risk＂ of the errors, the current basic medical insurance system, compared with working employees, retirement elderly people do not pay, personal accounts into more, The overall proportion of individual funds to pay lower policy concessions. Although there is a large amount of surplus in the annual health insurance fund, a large part of the balance is due to the relatively young age structure of the insured population and the low consumption of health insurance funds. With the increasing level of the aging of the insured population, the ratio of on-the-job and the backward is gradually reduced, the effect of these preferential policies will continue to enlarge, making the total fund expenditure increased significantly. Therefore, it is an important task to reform the basic medical insurance system in China to strengthen the research on risk control in the medical insurance fund of urban workers, to prevent and control the risks faced by the fund and to ensure the safety of the fund.

The Enlightenment of EU Real-World Evidence Supporting the Inclusion of Rare Disease Drugs in Medical Insurance Decisions to China

Objective To study the use of real-world evidence by EU and its member states for establishing a strategy for rare diseases and provide references for the inclusion of orphan drugs in China’s medical insurance.Methods A case analysis method was used to introduce the EU’s decision to include rare disease drugs in medical insurance by using real-world evidence because clinical data of rare diseases were difficult to obtain.Results and Conclusion China can use real-world evidence to make medical insurance decisions based on the experience of the EU and continue to invest more in rare diseases,which can solve the problem of few drugs for patients with rare disease.

Research on Social Medical Insurance of College Students in Shenyang

Objective To discuss the methods of improving the social insurance of college students by taking the application of college students’social insurance in Shenyang as an example.Methods The investigation and literature method were applied mainly.Results and Conclusion Through the questionnaire,the main problems for college students’medical insurance were analyzed in this paper,and proposals such as compulsory insurance,improving the level of medical services in colleges and hospitals,and strengthening commercial insurance and publicity were finally put forward.

Should Medical Insurance Cover Stop-Smoking Drugs?

At a seminar discussing ways to prevent chronic disease held in Shanghai on March 31, 2012, Chen Zhu, Minister of Health, revealed that the ministry was planning to include expenditures on counseling to stop smoking into the basic medical insurance system provided by the govern- ment, and would pay for drugs that help reduce dependence on tobacco.

Impacts of National Basic Medical Insurance Drug List adjustment on drug utilization in China: an interrupted time series study

Under Chinese medicine and health care system, Medicine Catalogue for National Basic Medical Insurance（2009） was issued in 2009 in China to fulfill the basic drug demands of the insured Chinese and to control the medical expenses. In this study, the influence of the list adjustment on drug utilization was investigated. With the comparison between inpatients＇ use of drugs before and after adjustment of Basic Medical Insurance Drug List, we classified the drugs adjusted in national list into six categories： class A to class B, class B to class A, class A to class C, class B to class C, class C to class A, and class C to class B（class A referring to overall insured drugs, class B referring to partial reimbursement drugs, class C referring to self-funded drugs in China）, and drug utilization and expenditure were analyzed with time series model. We analyzed the overall expenditure and average expenditure per 10 000 people based on the comparison before and after the adjustment of 2009 Basic Medical Insurance Drug List. The drug expenditure from class A to class B was decreased by 13.87% of overall expenditure and 16.37% of average expenditure per 10 000 people, and it was decreased by 38.74% and 48.03% from class A to class C; respectively, the drug expenditure from class B to class A was increased by 74.12% and 94.52%, while it was reduced by 19.79% and 14.52% from class B to class C; expenditure declined by 31.77% and 36.22% from class C to class A, and expenditure was increased by 12.42% and 22.05% from class C to class B, respectively, both were lower than before. The adjustment of National Basic Medical Insurance Drug List reduced the overall drug expenditure.

Analysis of reimbursement policy for outpatient chronic diseases in basic medical insurance for urban residents in China provincial capitals

Reimbursement policy for outpatient chronic diseases is an important part of the basic medical insurance scheme in China. The reimbursement policy for outpatient chronic diseases in basic medical insurance for urban residents of provincial capitals in China were analyzed from the perspectives of disease types, benefits package, qualification and health service access. Proposals to improve policy design, establish standardized disease inclusion criteria and set reasonable benefits package, strengthen management and complete supporting policy, strengthen policy coordination were put forward according the existing problems such as fragmented policy, great difference in disease types and benefit package, supervision difficulty, incomplete policy framework and lack of policy coordination.

Research on Reimbursement Management of Innovative Drugs Abroad and Its Enlightenment to China

Objective To analyze the reimbursement policies of innovative drugs in some developed countries,and to provide reference for future reimbursement management in China.Methods Literature research method was used to study the policies related to the reimbursement management of innovative drugs in Germany,France and Japan,and their successful experience was summarized.Results and Conclusion China should establish an open and transparent value evaluation standard to improve the medical insurance reimbursement management of innovative drugs.Besides,the value of innovative drugs should be taken as an important basis for reimbursement decisions,and an independent third-party value evaluation agency must be established.