Research On The Integration Of Urban And Rural Medical Insurance System

Since the basic medical insurance system has been established in 1998,China has gradualy established the medical insurance system based on the basic medical insurance for urban workers,urban residents basic medical insurance and new rural cooperative medical system(hereinafter referred as BMIUW,URBMI,NRCMS).In 2010,these three health insurance systems covered all urban and rural residents,but these three medical insurance systems are managed by two different departments.Urban health insurance(including BMIUW and URBMI)is managed by the human resources and social security department,while the NRCMS is managed by health department.With the economic and social development,this kind of ternary medical insurance model,which is established based on the separation between the urban and rural areas and distinction of identity,has brought many drawbacks.Problems like wasting of resources,duplication of institutions,repeated insurance due to no information sharing between urban and rural health insurance system and unsmooth transfer are increasingly appearing.This paper will take methods of data analysis,qualitative analysis and quantitative analysis and comparative analysis,etc.to analyse mature models of international medical insurance and the experience of integrating medical insurance,combined the result with the practical experience gained from the integration of urban and rural health insurance,run a comprehensive analysis of the integration of urban and rural medical insurance Management model in China.Besides,this paper will take Shanxi Province as an example,run the specific analysis of the policy changes before and after the integration of urban and rural health insurance and the risks and difficulties faced during this process,put forward the integrated management model which is suitable for China’s national conditions and provide consultative opinions for the national unified urban and rural health care management.The article is divided into three parts,the first part is theoretical study,the second part is the research of status quo and the third part is the policy recommendations.Through the comparative analysis of the international medical insurance integration model and the practical experience from areas which has been integrated in China,this paper tries to demonstrates its referential significance for the integration of medical insurance in China.31 provinces which either has completed the integration or has published integrated documents form several relatively typical models,judging from the management subjects after the integration,there are three types of management subject models: the first one is that the urban and rural residents health insurance or urban and rural unified health insurance is managed by the human resources and social security departments after the integration;the second one is that the urban and rural residents health insurance is managed by the health department after the integration;the third one is that the urban and rural residents health insurance is managed by a third-party other than health department and the human resources and social security department after the integration.Judging from the system model after the integration,there are basically three institutional models: the first one is the three insurance into one model,namely,BMIUW,URBMI,NRCMS unified into a basic medical insurance model.The second one is the model of three insurance into two with sub-filing which is in parallel with the workers health insurance.It combines the urban residents and the new rural cooperative medical insurance into the urban and rural resident’s medical insurance and sub-file them.The third model is model of three insurance into two without sub-filing,it combines the urban residents’ health insurance and the new rural cooperative,and unifies a financing standards and treatment standards.Through the comparative analysis of various models,it is concluded that the integration of urban and rural health insurance in China is divided into three steps.The first step is the establishment of the medical insurance system which covers different groups.This step includes the process from scratch,and achieves the full coverage of the system.The second step is the integration of the urban residents’ health insurance and new rural cooperative medical system,which two have similar financing model and the protection level,so that to the gap between urban and rural areas,identity restrictions can be eliminated and the health benefits equality of urban and rural residents can be protected.The third step is to complete the integration of urban and rural health insurance system.No one will be restricted by the household registration or identity,and everyone can make free choice of insurance under a unified system,so that the full integration of medical insurance system is achieved.At the same time,this paper provides some policy recommendations for the integration of urban and rural health insurance.First is to straighten out the management system,urban and rural health insurance management should be passed control to the human resources and social security departments,so that all social insurance projects managed by one department can be achieve.Second,the integration of urban residents’ health insurance and the new rural cooperative should be put in the first place,so that the two similar systems can be integrated first,then from easy to difficult.Third,gradually increase the urban and rural residents’ personal payment standards,so that urban and rural residents can gradually get rid of the excess welfare now and comply with its social insurance properties.Fourth,vigorously implement the "separate management and transaction",establish the independent legal person qualification of medical insurance agencies,so that commercial insurance companies can be entrusted to carry out medical insurance services.