Construction Of Evaluation Index System Of Basic Medical Insurance For Urban And Rural Residents And Empirical Research

Backgrounds:China established new rural cooperative medical insurance and basic medical insurance for urban residents in 2002 and 2007 respectively.However,due to the dual problem of urban and rural areas,there are great differences in the treatment of medical insurance between urban and rural residents.Therefore,in 2016,the state required the combination of basic medical insurance for urban residents and new rural cooperative medical insurance.After the merger,the basic medical insurance system for urban and rural residents was born.In 2018,the National Medical Security Bureau was established and a special organization in charge of residents’ medical security was established.It has been five years since the integration of basic medical insurance for urban and rural residents.The operation effect of basic medical insurance for urban and rural residents needs to be evaluated scientifically,reasonably and accurately.From the domestic research,the evaluation index system of basic medical insurance for urban and rural residents is not enough.Objective:This study established a basic health insurance evaluation index system for urban and rural residents on the basis of systematically analyzing domestic and overseas medical insurance system evaluation.In this background,this study aims to provide a basic health insurance evaluation index system for Chinese urban and rural residents through the combination of theory and time.The evaluation index system suitable for the medical insurance system was verified and evaluated,and the operation status of the current urban and rural basic medical insurance was scientifically evaluated.Evaluating the actual operation of the basic medical insurance system for urban and rural residents through empirical studies,find shortcomings and problems,and submit countermeasures and suggestionsMethods : In this study,the following research method was mainly operated by combining subjective judgment and objective practice when constructing the basic health insurance system evaluation index system for urban and rural residents.Search literature on evaluation to obtain key indicators,organize and organize them based on them,and build indicator maps.2.Structure-process-result evaluation method: This method has very strong practicality as it can be applied not only to the field of medical hygiene but also to the evaluation of all items.The structure-process-result evaluation method is also applied to the evaluation of basic health insurance for urban and rural residents.3.Delphi method: Through two Delphi methods,the evaluation index is increased or decreased and the index system is supplemented.4.Dimensional analysis method: The weighting coefficient of the 1st,2nd,and 3rd grade indicators is determined using the dimensional analysis method.5.Comparative analysis method:In the empirical study,we compare and analyze the operation situation of urban and rural residents’ basic health insurance integrated so far,study problems,and make recommendations.Results : Based on theoretical analysis,team discussion,and expert advice,the following research results were obtained.1.The basic health insurance evaluation index system for urban and rural residents was initially established through index selection and expert discussion.It includes 3Level 1 indicators,11 Level 2 indicators,and 46 Level 3 indicators.2.Results of the first expert consultation: The expert positive coefficient reached 100%,and the expert’s authority coefficient for the importance and validity of the indicator was between 0.7-1.After the first expert consultation,11 indicators were adjusted and 11 indicators were added.6 indicators were deleted.After the adjustment,there are 3first-class indicators,12 second-class indicators,and 53 third-class indicators.3.Results of the second expert consultation: The positive coefficient of experts reached100%,both significance and relevance were greater than 4.0,and the coefficient of variation was less than 0.25.The harmonization coefficients of the experts on importance and validity were 0.238 and 0.214,respectively,which were higher than the primary results.4.The weight of the 1st,2nd,and 3rd grade indicators is confirmed through the dimensional analysis method.The weight of the first-class indicators is system design（0.2564）,system operation（0.3350）,and operation effect（0.4086）,and the weight of 12 second-level indicators is government subsidy（0.1992）,policy claims（0.3251）,and insurance payment（0.4757）.,service availability（0.0881）,fund flow（0.1285）,handling management（0.1542）,payment system（0.3468）,supervisory management（0.2825）,substantive claim（0.1650）,crowd burden（0.2164）,fund stability（0.4364）,Satisfaction（0.1822）.As a result of the consistency check,if the CR value is less than 0.1,it indicates that the consistency of matrix construction is relatively good.Conclusion:This study establishes a basic health insurance evaluation index system for urban and rural residents according to the structure-process-result evaluation method,and determines the weighting coefficient of the index through two expert consultations.The practicality of the evaluation index was verified by providing an evaluation basis for the operation of He suggested that the insurance system be continuously supplemented to realize the goal of a healthy China.