A Research On The Management Innovation Of Medical Insurance Personal Account From The Perspective Of Cooperation Between Social Insurance And Commercial Insurance

As an important part of the basic medical insurance for urban workers,the individual account of medical insurance plays an important role in the reform of the medical insurance system,the saving of medical insurance funds and the promotion of medical insurance for urban workers,however,in recent years,the individual account of medical insurance has exposed some systematic problems,such as lack of horizontal mutual benefit function,weak accumulation ability and appropriation of the fund of the overall account,which once aroused the attention of the academic and practical circles.The notice on 《Doing a Good Job in Basic Medical Security for Urban and Rural Residents in 2019》clearly stipulates that individual accounts for residents’ medical insurance shall be completely banned by the end of 2020,then set off the employee health insurance personal account of the discussion upsurge,experts and scholars around the current should cancel the health insurance personal account launched a heated discussion.What to do about the individual account of medical insurance will directly affect the efficiency of medical insurance.In 2020,the State Council issued its latest "opinions on deepening the reform of the medical security system," which clearly stated the need to "reform individual accounts of basic medical insurance for workers," The reform of personal account is an important part of deepening the reform of medical security system,and it is also a touchstone to test the work of Medical Insurance Department.Based on the above background,this paper first makes clear the original intention of setting up the individual account of medical insurance in China and its operating results,then analyzes the current operating situation of the individual account of medical insurance,selects Guangzhou City as the research city,through the policy research and the research data comparison,to find out the problems existing in the management of personal accounts,and combining with the differentiated needs of employees for medical security,to draw out the practice of personal accounts participating in the cooperation between social enterprises and businesses,and to draw on and refine the experience,finally,the author puts forward the innovative scheme and supporting suggestions for the individual account of medical insurance to participate in social business cooperation.This article includes six parts,each chapter’s main research content and the research viewpoint are as follows: The first chapter is the article introduction.Including the background and research significance of this paper,the status quo and review of the research on employee medical insurance personal accounts,research content,ideas and methods,innovation and deficiencies.The second chapter carries on the localization to the staff and workers medical insurance personal account function.First of all,it combs the process and policy features of China’s basic medical insurance system for urban workers.The basic medical insurance for urban workers was formally established in 1998 and occupies an important position in our medical insurance system,its policy characteristic is to set up the overall plan fund and the Individual Account Parallel unified account pattern.Then it expounds the functions,modes,operational effects and deficiencies of the personal account,which has the functions of transition,payment,restriction and accumulation,in the process of operation,it plays an important role in function,relieving financial pressure and reducing the cost of medical insurance management.At last,the paper analyzes the current situation of the personal account,and summarizes the coverage,financing mechanism,fund management,reimbursement scope and fixed-point management.The third chapter points out the problems existing in the management of employee medical insurance personal account.First of all,based on a field survey in Guangzhou,the results were summarized from four dimensions: The distribution of basic information,the distribution of medical service,the knowledge of medical insurance policy,the use of personal account and the distribution of expanding intention.Then it summarizes the issues existing in the management of personal accounts,and finds that there are unfair phenomena in the financing and treatment of personal accounts,the control of fees is not obvious,which easily leads to moral hazard,the accumulation ability is weak,which leads to the deposit of funds;Individual accounts reduce the overall fund’s ability to pay,the payment base is difficult to implement impact on the implementation of health insurance policies and other issues.Finally,the necessity of abolishing the personal account is discussed,considering that the personal account is mainly derived from the personal contribution of workers,has the attribute of private property,and has its proper function,so it is not recommended to be abolished directly,but to be innovated in management,activating the mutual aid function of personal accounts.The Fourth Chapter Analyzes the Innovation Direction of personal account management.From the different angles of age,household registration,occupation and family structure,this paper classifies the risk of employees,and draws an important conclusion that there are differences in health risk exposure among different groups,workers have different needs in major disease insurance,supplementary medical insurance,accidental injury medical insurance,self-financed drug insurance,family insurance and cross-regional service.The third chapter summarizes the urgency of extending the mutual aid function of personal account,and draws out that personal account can satisfy the differential medical security needs of employees by purchasing commercial health insurance,participating in social-business cooperation and activating the function.The fifth chapter compares the Innovation Paths of personal account management in typical regions at home and abroad from the perspective of social-business cooperation.First of all,it explains the connotation and necessity of social-business cooperation in medical insurance,and then based on the practice of individual accounts participating in social-business cooperation in Singapore,Shanghai,Shenzhen,etc.,the differences of participation content,participation mode and participation effect among different regions were compared and analyzed.With the advantage of market competition,the cooperation of medical insurance companies can not only speed up the construction of multi-level medical security system,but also alleviate the pressure of medical insurance departments.Through the analysis of the practice in the three places,it is found that the Singapore private insurance scheme aims to provide the extra benefit protection of the life health insurance for the insured.The Central Provident Fund and seven insurance companies have signed a cooperation agreement,provide insurance products and services.Shanghai learned from the Singapore model,and the Shanghai Medical Insurance Bureau formed cooperation with nine insurance companies.The insurance products have a high degree of standardization and a wide variety of products,but there is a free form of purchase,which leads to a lower participation rate and a lack of regulatory system,the personal account balance does not support the use of family members and so on,which enlightens us to standardize the purchase form,to increase the insurance rate,to formulate unified supervision policy and to expand the family sharing function of personal account.In the Shenzhen Model,the Shenzhen Medical Insurance Bureau only cooperates with Ping an pension insurance company.It has the product advantages of "low insurance premium and high security",but it has the disadvantages of single product structure and insufficient sustainability of participating in social-business cooperation,it enlightens us to enrich the product types and adjust the premium income and the insurance coverage appropriately.The sixth chapter puts forward the innovative scheme and supporting suggestions of the staff and workers’ medical insurance personal account participating in the cooperation between social enterprises and businessmen.In accordance with the management logic,first of all,relevant suggestions were made to the main administrative body of the health insurance administration department,then the content and modes of cooperation of social enterprises were prospected,and finally,the resources of commercial insurance companies and insurance brokerage companies were integrated,we will give full play to their multi-faceted auxiliary role.The Medical Insurance Department should formulate the supervision and management policy of individual account participating in social business cooperation,clarify the power and responsibility,optimize the public service flow of medical insurance,widen the service channel of medical insurance,and explore the establishment of cross-regional medical insurance management coordination mechanism Commercial Insurance companies should give full play to market-oriented characteristics,provide convenient and efficient services,and do well in management and management services.In addition,the cooperative management mechanism innovation should be strengthened,including information system co-construction and sharing,network platform docking,establishment of cooperative business communication mechanism and other measures.Then the feasibility of this innovative scheme is demonstrated.It is found that workers’ awareness of insurance is increasing and they are willing to participate in insurance The technology based on big data and electronic payment is feasible,and the law based on the demand of workers’ security is feasible.At last,the author puts forward some suggestions for the above-mentioned innovative schemes,including insisting on multi-win-win thinking,establishing family sharing system of individual account balance,optimizing the environment of participating in insurance,and encouraging the employees and their families to participate in insurance actively.The main research features and innovations of this paper are as follows:(1)Based on the field survey data of Guangzhou City,the innovative plan fully integrates the local characteristics.Under the overall planning of medical insurance at the municipal level,there are obvious regional differences in China’s economic development,population structure and individual account operation,the operation of the local staff Health Insurance Fund,economic development level and the characteristics of the industrial structure,so that the proposed program targeted.The research contents are closely combined with the practice,and the practicability and application value of the research results are emphasized.(2)Innovatively put forward the program of individual account participating in cooperative business.This paper summarizes and summarizes the excellent experience of various places,and holds that individual account participating in cooperative business can realize mutual benefit and share risks,and adhere to the thought of win-win,to promote the sustainability of the system,we should fully arouse the enthusiasm of the medical insurance departments,commercial insurance companies,insurance brokerage companies and the insured,strengthen the innovation of the management mechanism of social-business cooperation,and highlight the role of insurance intermediaries.