The current issue, "Medical Cost Control", is popular on account of the sudden cost control in part of China’s hospitals, resulting in the inconvenience of medical staff and patients as well. A number of Chinese provinces have issued a notice that expanding the range of payment according to disease category.This is actually an important measure of Medical Cost Control.
“医疗控费”这一话题最近大热，源于部分医院“突击控费”，造成医务人员工作不便、患者就医不便的反响。多个省份密集发布扩大按病种收付费范围的通知，医院按此标准收费，医保基金和参保患者按规定比例付费，这实际上就是医疗控费的重要措施。
Different participants have different interest demands on Medical Cost Control – people want to pay less for better personalized health service, hospitals have an urgent need to reduce medical cost, insurance companies hope to avoid high compensation rate and long claiming cycle.
针对医疗控费的难题，不同参与方有着不同的利益诉求：受众希望降低保费，获得更为优质而个性化的健康服务；医院有着降低医保费用的迫切需求；保险公司则希望避免出现赔付率高、赔付周期长的不利局面。
Along with the improvement of China’s basic medical insurance coverage,pressure of medical insurance fund payment has keeping increasing. Though the development of commercial health insurance in China is still in the initial stage, it shows positive trend but with variables.Thus, many problems need to be solved by Medical Cost Control, such as the imbalance of medical insurance fund, fraud, excessive medical treatment, payment reform, PBM etc.
随着基本医保保障范围和水平的提高，医保基金的支付压力也与日俱增；我国商业健康保险的发展还处在初级阶段，虽然呈现出积极良好的势头，但仍然存在较多变数。因此，医疗控费需要解决的矛盾很多，比如医保基金收支不平衡、骗保、过度医疗、支付方式改革、药品福利管理等。
The present Medical Cost Control is gradually trying to evolve from the traditional manual way to technological smart method combining with Big Data. The future pursuit may be Managed Care mode. Cost will be controlled before disease occurs if adopt Health Management.The digital transformation, precise and personalized medical treatment, advanced technology are also the significant development paths for insurance companies.Through Medical Cost Control, the industrial chain among insurance companies, hospitals, and pharmaceutical enterprises can be further paving for Health Management.
现阶段的医疗控费，逐步尝试从传统的人工稽查和医学规则审核转型到利用大数据技术实现智能控费；更高阶段的医疗控费，应该是学习管理式健康医疗保险模式，做健康管理，把费用控制在疾病发生前。医疗行业数字化转型、精准和个性化医疗、整合先进技术也是保险公司对于控费的可观发展之路。通过医疗控费可以进一步打通商保、医院、药企之间的产业链，为健康管理铺路。
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