Medical overuse is a persistent problem in medical insurance services. Differences in perception, interpretation of "overuse" lead to controversies in the supervision of medical insurance funds, it is difficult to define, identify, deal with overuse problems. This paper compares the connotation, boundary of medical overuse through a literature review. Based on this, we form a system of medical overuse indicators, including5first-level indicators, 30second-level indicators, 67third-level indicators, by digging deeper into the medical insurance supervision texts, the medical overuse behaviors seized during the supervision process of designated medical institutions. The system is based on international experience, provides suggestions, an evidence-based basis for optimizing, refining the application of medical overuse supervision rules
Key words
medical overuse /
medical insurance supervision /
indicator system
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References
[1] 崔新民,张红霞.医疗机构过度医疗行为监管难点及对策[J].人力资源管理, 2018, (7): 1.
[2] SPIEGEL A. More is Less [Z]. This American Life.2009. https://www.thisamericanlife.org/391/more-is-less.
[3] MCCUE M T.Clamping down on variation [Z]. Wayback Machine - Managed Healthcare Executive. 2007.
[4] HENSHER M, TISDELL J, ZIMITAT C.“Too much medicine”: Insights and explanations from economic theory and research[J]. Social science & medicine, 2017, 176: 77-84.
[5] REILLY B M, EVANS A T.Much ado about (doing) nothing[J]. Annals of internal medicine, 2009, 150(4): 270-1.
[6] FISHER E S, WENNBERG D E, STUKEL T A, et al.The implications of regional variations in Medicare spending. Part 2: health outcomes and satisfaction with care[J]. Annals of internal medicine, 2003, 138(4): 288-98.
[7] SNYDER L, American College of Physicians Ethics P, Committee H R. American College of Physicians ethics manual[J]. Annals of internal medicine, 2012, 156(1_Part_2): 73-104.
[8] BERWICK D M, HACKBARTH A D.Eliminating waste in US health care[J]. Jama, 2012, 307(14): 1513-6.
[9] RALSTON S L, SCHROEDER A R.Doing more vs doing good: aligning our ethical principles from the personal to the societal[J]. JAMA pediatrics, 2015, 169(12): 1085-6.
[10] KLUG ENTSCHEIDEN [Z].KLUG ENTSCHEIDEN [Z]. Deutsche Gesellschaft für Innere Medizin e.V. 2022
[11] LEHMANN C, BERNER R, BOGNER J R, et al.The “Choosing Wisely” initiative in infectious diseases[J]. Infection, 2017, 45(3): 263-8.
[12] ODUNCU F S.Priority-setting, rationing and cost-effectiveness in the German health care system[J]. Medicine, Health Care and Philosophy, 2013, 16(3): 327-39.
[13] CARDONA-MORRELL M, KIM J, TURNER R M, et al.Non-beneficial treatments in hospital at the end of life: a systematic review on extent of the problem[J]. International Journal for Quality in Health Care, 2016, 28(4): 456-69.
[14] DRUML W, DRUML C.Overtreatment in intensive care medicine[J]. Medizinische Klinik, Intensivmedizin und Notfallmedizin, 2019, 114(3): 194-201.
