Study On The Implementation Of Direct Settlement Policy Of Urban Employee Basic Medical Insurance In Different Places In Jilin Province From The Perspective Of Policy Network

With the deepening of the reform of the medical and health system,China’s medical security system has been continuously improved,and the universal medical security system has basically taken shape.In the process of rapid development of urbanization,China’s elderly population is increasing,population migration is becoming more and more frequent,the phenomenon of medical treatment in different places is becoming more and more common,the territorial separation of medical treatment behavior and medical insurance relationship,the contradiction between the direct settlement of medical expenses of insured persons in different places and the localized management of the current medical insurance system,resulting in a series of problems such as expensive medical treatment and difficulty in reimbursement in the process of medical treatment in different places,in order to protect the reasonable medical insurance rights and interests of the insured in the process of seeking medical treatment in different places,since 2009,China has successively issued a series of policy documents for remote medical treatment,began to explore and continuously improve the settlement and management of remote medical treatment,so far achieved certain results,the national network remote medical settlement platform is fully operational,the scope of remote medical coverage personnel has gradually expanded,and the cost settlement project has gradually expanded,from remote hospitalization to outpatient medical treatment to outpatient chronic disease treatment.As one of the pilot cities for direct settlement of medical treatment in different places,Jilin Province has been actively responding to the call of national policies,and based on the actual situation of Jilin Province,it has issued provincial-level policy documents for remote medical treatment,promoted the effective implementation of the policy of remote medical treatment,and made certain efforts to solve the problem of remote medical treatment.This paper is divided into five parts: first,it defines the concepts of remote medical treatment and direct settlement for remote medical treatment,and discusses in detail the relevant content of policy network theory.The second is to systematically sort out the development process of the direct settlement policy for medical treatment in Jilin Province,and specifically analyze the characteristics of the implementation of the direct settlement policy for medical treatment in different places.The third is to use the policy network theory to analyze the composition and characteristics of multiple policy actors affecting the implementation effect of the policy of direct settlement for medical treatment in different places in Jilin Province: policy community(central government),intergovernmental network(local government),producer network(designated medical treatment,medical institutions),professional network(medical insurance experts and scholars)and issue network(patients seeking medical treatment in different places),and analyze the complex interaction process between various actors in policy implementation from a micro perspective.Based on the results of interviews and questionnaires,it can be seen from the two perspectives of the behavior choices of various policy actors and the interaction between different subjects,it can be seen that there are difficulties in the coordination between intergovernmental networks in the implementation of the policy of direct settlement of basic medical insurance for urban employees in Jilin Province,and insufficient response to the policy community.Producer networks are too dependent on intergovernmental networks to exert autonomy;The issue network has insufficient interaction with the intergovernmental network,limited participation in the three issues,and in-depth analysis of the causes of the problems.Fifth,in view of the problems and causes,combined with theory and practice,put forward suggestions for optimization paths,mainly from the public interest as the guide,integrating the conflict of interest of the policy community and the intergovernmental network;Strengthen multi-subject supervision of intergovernmental networks,and improve and improve the multi-entity supervision system;Improving the autonomy of producer networks and creating good conditions for policy implementation;Increase the ownership of issue network resources,improve the public participation mechanism,optimize the behavior of subjects and the interaction process between subjects,solve existing problems,and promote the effective implementation of the settlement policy for medical treatment in different places.