Policy Analysis And System Improvement Of Basic Medical Insurance For Urban Residents In China

The medical insurance system for urban residents in China has made certain achievements since start a pilot in2007, but also faces many problems. In order to understand the operation of the medical insurance policy for urban residents, found the problems and the reasons for the pilot, summing up the experience of the pilot, perfect city home insurance policy to provide the scientific basis for decision making.This study used the literature, historical analysis, comparison of policies, empirical analysis research methods to explore the problems faced by the medical insurance system for urban residents, Proposed the main research content. This paper will focus on the following four aspects:(1) The changes and influencing factors in the course of the urban residents medical insurance policy, as well as the characteristics and problem in Change of the medical insurance system for urban residents (2) The core policy objectives and the status of implementation of the basic medical insurance for urban residents medical insurance policy, the current operation of pilot cities for urban residents medical insurance policy and what progress has been the policy objectives in the core of the system fair?(3) The policy assessment and risk identification of the medical insurance for urban residents, focus on the situation of the Participating willingness and What factors impact of residents insured?what about the situation of the service utilization and what factors affect service utilization?what about the situation of the institutional Satisfaction and what are the implications of resident satisfaction?(4) Which system bottlenecks and deep-seated problems face by the medical insurance for urban residents? What kind of support measures to improve and promote the reform of the medical insurance for urban residents? Through research and answer these four aspects of the problem in order to achieve the purpose of carding policy context, to provide theoretical guidance,to understand the policy status quo, identify the policy risk, and provide the policy recommendations. First of all, from the policy changes history of the medical insurance system for urban residents, there are three main stages of the related policies on medical insurance for urban residents since the founding of the PRC:First,the"half fee" stage to protect residents dependent on public funds and the labor insurance system (1951-1992). Second, the self protection phase by residents under the system missing (1993-2007). Third, the pilot and improvement phase of the urban residents medical insurance policies (2007-present). The study found that financial constraints and government concept is the primary influence factors of the urban residents medical insurance policy changes, path dependence of the development of traditional health insurance policy and weak interest groups also indirectly affect the ranking insurance policy introduced. From the view of Opportunity for institutional change, policy vacancy and the diffusion of new medical reform policy issues become a key factor in determining the urban residents insurance policy introduced. Overall, China’s medical insurance system for urban residents is a gradual reform, with the characteristics as a combination of top-down and bottom-up; Induced and Imposed; systemic reform from the emergency.Secondly, this study used the nine cities of the State Council on the pilot survey of urban residents medical insurance as the blueprint,do the detailed analysis and comparison of the policy operation of the basic medical insurance system for urban residents.Analysis and comparative study of the policies and regulations of the insured population, funding criteria, service utilization, policy treatment, management and supervision, and other aspects of urban residents’ basic medical insurance policy, to identify the common characteristics of the pilot cities insurance policies, experience and inadequate. Thought the empirical survey data of the nine cities to understand the insurance insured, financing, service utilization, the actual benefit of residents, the burden of residents and system satisfaction were analyzed to identify policy problems and risks.From the funding fairness of the medical insurance policy in pilot cities, use the income quintiles fairness which is generic use by international research, calculate the Gini coefficient, concentration index and Kakwani index to analyze the fairness of Basic medical insurance for urban residents. By calculating, the Kakwani index of the Medicare financing of urban residents in2007is0.18. The description of the fund-raising in the crowd is progressive, show that fund-raising income fairness improvement. The Kakwani index of the medical insurance for urban residents in2011is0.37. Medicare financing of urban residents show the progressive characteristics, demonstrate that the burden of the health financing relatively high-income residents of lower-income residents bear light. Reflects the fairness of the funding in the medical insurance system for urban residents. From the services fairness of the urban residents medical insurance in pilot cities. The urban residents demand and utilization of medical insurance Investigate in pilot cities show the following salient features:First, the demand for services and income does not match, the lower-income population more susceptible to disease, the higher the demand for services, there are closely related to health and income inequality. Low-income groups in the prevalence rate, the prevalence of chronic diseases, sick bed rate far higher than the high-income group. Second, is closely related to service utilization and income. Lower income groups, the higher the proportion of not visiting. In the calendar year due to the economic difficulties without doctor proportion are key factors. With the reduction of income, did not seek treatment than the obvious highest.From the burden fairness of the urban residents medical insurance in pilot cities, the phenomenon that poverty due to disease still exists. Studies have shown that although the urban residents medical insurance played a certain role to alleviate and reduce catastrophic expenditures and poverty caused by medical, but due to the family economic situation and the severity of the illness, the actual burden of "unfair" phenomenon still exist. The study also specialized research and evaluation of the insurance, service utilization and satisfaction for urban resident medical insurance policy in pilot cities. First, view from willingness to insured medical insurance system for urban residents, the growth of the insured enrollment rate is relatively rapid. But over the years there are a small part of the population should be insured but not insured, which will bring certain risk of "adverse selection". Secondly, view from the service use of the medical insurance system for urban residents, although the introduction of the insurance system of urban residents is late, but it has the advantage of the system, relatively fast development characteristics. The prevalence of the Insured residents and the population should be insured but not insured basically not much different. The policies lack of attractive to uninsured residents. Again, from the factor impact of urban residents medical services utilization, gender, age, education level, marital status and other personal characteristics and health status changes, whether illness and other health factors has a significant impact on whether or not to participate in the examination; the effect of whether treatment by marital status, health awareness and household income of illness was not significant. In addition to the factor significantly whether have illness within two weeks, other factors were not significantly affected on whether it should be hospitalized and non-hospitalized.Finally, the research summarizes the bottleneck of China’s medical insurance system for urban residents in the pilot process, combined with the academic theoretical exploration as well as the opinions of expert advice on the development of the medical insurance system for urban residents, put forward a sound policy recommendations and implementation path on the basis of the reference to some typical local experience and practice of China’s medical insurance system for urban residents.From the bottlenecks facing by the current system, there are some real problem which is urgent need to slove in every aspects of the medical insurance or urban residents:(1) In the insured aspect:the defined of the crowd which shoud be insured is unclearly; the scope of the insuredis is too narrow due to the household registration system, most of the floating population and migrant workers exclude outside the system; continuous enrollment incentive is weak;"voluntary insured" caused a certain degree of selectivity insured,the coverage extension system quickly but may be difficult to maintain.(2) In the fund-raising aspect:the financing and financial compensation classification is too complex; the funding levels growing too fast, causing the unequal burden on local government finances and local residents.(3) In service utilizati aspect, the utilization of insured still inequality caused by income, insured residents are not satisfied with the coverage and the level of protection. The medical insurance service also needs to be improved.(4) In the management and co-ordination aspects, the Medicare fund management too much emphasis on the financial balance and balances with high levels lead to the loss of system efficiency;the medicare payment system is still unscientific,the effective mechanism for purchase of medical services is;the medical insurance for urban residents unable to form with the reform of the health care system; the problem to co-ordinate convergence urban residents medical insurance to other system is gradually revealed.With regards to this, this study starting from the consideration of policy ideas, policy principles, policy environment, policy feasibility. Further focus on the main problems in the optimization of the process of reform of the medical insurance system for urban residents based on the evidence-based decision-making theory, Finally, put forward policy recommendations to deal with the problem in all aspects. greatly emphasis that under the background that to improve the guaranteed level of funding and the level of protection of the urban residents is is very limited in the short term, there is an urgent need for the three aspects of reform:First, do the reform of the Medicare payment system; Second, do the reform with the health care system reform, promote the community health services, especially family responsibilities doctor system construction, to form "the doorman system."for the health care;Third, we must strengthen the supervision and management of the health insurance fund to improve the efficiency of health care institutions manage.