Research On The Optimum Premium Model Levels Of Basic Medical Insurance For Urban Residents In Wuhan

ObjectiveThis study is a theoretical exploration and empirical research of the model calculation of minors'payment level, based on the framework of basic medical insurance for urban residents. It is a beneficial exploration of design ideas based on different ages and different payment levels and standards. By doing literature and empirical research, combining qualitative research with quantitative research, studying materials about the medical insurance payment level of minors at home and abroad, the study analyzed and summarized the similarities and differences of the levels and models of Medicare payment in the pilot cities. Taken Wuhan city as an object of study, analyzes the consumer demand characteristics of the minors'basic medical insurance and expenses of material benefits fund in Wuhan. Using medical insurance theory, actuarial science theory, sociology and economics theories and methods related to financing,①to establish health care appeals and the multi-priority relationship which involves government, health care departments, minors and their families;②to study minors the key parameters and calculation method of minors'payment level, to build a mathematical model for an appropriate payment level of minors;③to demonstrate and amend the core parameters and constraints in building the theoretical model, providing the basis to determine an appropriate payment level. Research Methods (A) Document analysis Consult related literature on domestic and international medical insurance premiums, funding levels, compensation expenses, the insurance factors, willingness to pay, and the payment level and mode of minors in pilot cities, using content analysis method to compare the contents to figure out the theories and methods which can be utilized in this study.(B) Expert consultationInquire the experts in health insurance, health economics, health management, medical sociology about the priority among minors division by age, health insurance compensation expense growth factors, government, health care departments, juvenile and family parties and other issues. By expert panel, launch a discussion on these issues.(C) Focus group discussionsLaunch focus group discussions on government and related departments'calculation basis of minors'payment level, health care appeals and the dynamic mechanism of the level. Each group consisted of 4-6 members from human resources and labor security department, finance department, health administration, health care agencies.(D) Insider interviewBy interviewing medical insurance management department insiders, understand the current basic ideas and methods of calculation of minor health insurance payment level.(E) On-site surveyTake Wuhan as an object of study, in accordance with the social and economic development, geographical characteristics and distribution of medical resources, select Jianghan District, Qingshan District, Hongshan District, and Huangpi District as locations of the site survey. Investigate the insurance case of minors, material benefits fund expenditures, the residents health insurance agencies'calculation basis of minors payment level and target resorts, levels of medical institutions for minors' medical treatment, basic medical care spending, the situation of the insured health care residents and willingness to pay and so on. About 500 families of minors are chosen in each location. The specific content of the survey, including levels of medical institutions for minors' medical treatment, basic medical care spending, and residents insured situation and willingness to pay and so on. (Vi) Data analysis methods ①Use descriptive statistical analysis and multi-factor analysis of variance to analyze the characteristics of minors basic medical consumer demand;②Use the four-step model method to construct the calculation model of minors basic health consumer spending;③Using home questionnaires, initial bidding method and direct method, to calculate families' willingness to pay;④Use the AHP to adjust the precedence order of the government, health care departments, juvenile families demands and target resorts;⑤Build a calculation model for an appropriate payment level of minors medical insurance.Results:(1) The age groups of insured minors were divided into:0-1 years old,2-3 years old,4-6 years old,7-12 years old,13-18 years old.(2) The basic formula for Per capita medical insurance financing is: S'=(Go·Po·Ko·Eo·Co+Gi·Pi·Ki·Ei·Ci)/(82%～96%)Go refers to per capita rate of out-patient treatment in one year; P o refers to per out-patient health care costs, Ko refers to the proportion of out-patient compensation, Eo refers to out-patient insurance factor, Co refers to out-patient increasing coefficient;Gi refers to the per capita rate of hospitalization treatment in one year; P; refers to per hospitalization costs; Ki refers to the proportion of hospitalization compensation; Ei refers to hospitalization insurance factor; Ci refers to hospitalization increasing coefficient.(3) From 2008 to 2010, the actual compensation rate for minors was 58.6%; if taking account of all the minors in 7 center districts in Wuhan, the insurance factor was approximated 1.0. If taking account of differences health costs in different level hospitals, the insurance factors of grade one, two, three medical are approximately 1.10,1.15 and 1.20 respectively. The minors of different ages hospitalized in different levels hospitals, the growth factors of outpatient and hospitalization costs were different; if adopting health care cost ratio method, the mean growth factor is 0.538; If taking pharmaceutical industry CPI as estimated growth coefficient ratio, it was 0.420; if adopting comprehensive ratio method, it was 0.745.(4) From 2008 to 2010, In Wuhan City, two weeks prevalence, two weeks treatment rate and per capita outpatient rate are not very different (P>0.05). It shows that the disease incidence in Wuhan is a relatively stable disease model. The two weeks prevalence, two weeks treatment rate and per capita outpatient rate changed much. The two weeks prevalence, two weeks treatment rate and per capita outpatient rate of 0-1,2-3 years old and 4-6 years age group, male and female are not very different (P> 0.05),while 7-12 years old and 13-18 years old age group, male and female are significantly different(P<0.01).(5) The relationship between health care costs with gender and age. The influences of gender and age on health care expenses are significant. The structure and the number of health care costs of different age groups are quite different. The health care costs of 13 to-18 age group were significantly different. The health care costs and hospitalization rate of 2-3 years and 4-6 years age group are higher. The health care costs of 13-18 years old group are quite different.(6) The influence of family income on health care costs. After a minor illness, if taking the development of social and economic factors as the same circumstances, the medical care cost increases as family income increases, and each 1% increase will cause health care cost increased by 0.6839 percent. If taking account of the price factor in growth and family Engel coefficient, due to the rigidity of the basic features of consumer demand, health care cost has become an important component of household expenditure. Health care cost is closely related with phases of the physiological and psychological development, and also the type of illness and its distribution.(7) the relationship between willingness to pay for health insurance and health care costs. Residents are more willing to pay health insurance for minors according to the level of the residents health insurance.ConclusionsThe study on measuring model of medical insurance financing is still in preliminary exploration stage. The minor's physical and mental development characteristics and disease distribution and structure cause determine the complexity of financing measuring. The household income is positively related with willingness to pay, but due to demand for health care services are rigid, especially the demand for medical care services for minors is larger, so the government and the medical insurance management department must be careful to put forwards relevant rules, financing standard, medical expenses, compensation ratio. Some domestic scholars have proposed the concept of the insurance factor, and argued that medical expenditures will grow as the compensation ratio increases. But insurance factor was limited to the linear model, and the coefficient estimates are not accurate, which results in considerable problems for reasonable estimates of medical expenses. The research made a comprehensive comparison of domestic and foreign research results and the experience of one city, and set the corresponding demographic indicators (gender and age), household income, willingness to pay and disease type (including its distribution), and other factors affecting Empirical study of medical expenses, and combined the classification of medical insurance with the generalized linear model to reflect the role of the insurance factor, and so provided new ideas and methods to improve the management of minor medical insurance system.