Research On The Diffusion Of Provincial Critical Illness Insurance Policy Innovation

Policy innovation is an important part of the public policy formulation process,and the diffusion of policy innovation is an important issue in policy innovation research.Critical illness insurance,as an important policy innovation in China ’s medical security system,plays an important role in reducing the burden of medical expenses for patients with major diseases.Premier Li Keqiang pointed out:"Seeing a doctor,especially serious illness,is a pain point for people’s livelihood.Critical illness insurance is also a creation in the world." In 2009,Jiangxi took the lead in introducing supplementary medical insurance for residents at the provincial level.After 6 years of diffusion,31 provinces in mainland China have adopted the critical illness insurance policy by the end of 2014.The diffusion of this important policy innovation has aroused widespread concern in academia.What are the characteristics of provincial illness insurance policy innovation in the diffusion process?What changes have taken place in the content of critical illness insurance policy in the diffusion process?What factors will affect the diffusion of provincial critical illness insurance policy innovation?The above key issues are still unclear.From the perspective of policy innovation diffusion,this paper takes critical illness insurance as the research object,conducts two studies on diffusion process and diffusion influencing factors,and tries to answer the above questions.The first research explores the diffusion process of provincial critical illness insurance policy innovation by qualitative analysis.Firstly,in terms of characteristics:(1)the diffusion of provincial critical illness insurance policy innovation presents a S-shaped curve model in the time dimension;(2)The spatial dimension has a"pioneer-follower" effect and proximity effect,which is manifested in the leading policy innovation of east and southwest China,and the mutual learning and imitation of provincial governments in adjacent regions;(3)In the organizational level dimension,under the management system of "block structure",provincial governments explore the innovation of critical illness insurance under the authorization of the central government,and present a gradual pilot path in the interaction process of "absorption-radiation".Secondly,in terms of results:The policy content of critical illness insurance presents a changing path of "absorption-radiationreabsorption" in the process of diffusion,and finally rises from spontaneous exploration of local experience to formal policy arrangements at the national level.The second research uses the event history analysis method to test the influencing factors of the diffusion of provincial critical illness insurance policy innovation.The research finds that:(1)the pressure of the central government,the pressure of adjacent provinces,and the funds for critical illness insurance have a significantly positive impact on the adoption of critical illness insurance policy innovation by provincial governments;(2)the level of health management has a significantly negative impact on the adoption of critical illness insurance policy innovation by provincial governments;(3)the impact of critical illness medical demand,insurance industry foundation and economic growth vitality is not obvious.The above results show that when the provincial government adopts the innovation of critical illness insurance policy,it is neither the "Muppet" driven by external pressure,nor the "rational economic man" acting entirely in accordance with the maximization of returns,but the limited rational innovation actor affected by the relatively stable institutional structure.Based on the results of qualitative analysis and event history analysis,this paper puts forward the following suggestions for the policy innovation and diffusion of follow-up critical illness insurance:first,optimize the top-level design to solve the conflict between goals and practice;second,deepen multi-agent coordination mechanism and improve the degree of information sharing;third,establish multi-channel financing model and pay attention to fund actuarial balance;fourth,focus on key groups and implement precise protection.