A Study On Additionnal Insurerance To Health Care Of Tianjin

Both the Basic Medical Insurance (BMI) and Supplementary Medical Insurance (SMI), essentially speaking, are the risk sharing mechanism towards the certain group of people in the disease cost concerned. At present, the BMI for urban employees & residents (URBMI) and the New Type of Rural Cooperative Medical Care System (NCMS) have covered 1.2 billion populations in China. BMI, including the BMI for urban employees, the urban and rural residents has been involved more than 95% population in Tianjin. That is t say; most of the people here have the policy guarantee in BMI. In view of the present situation, Supplementary Medical Insurance (SMI) development will focus on how to guarantee requirement above the BMI and the individual groups with heavy burden in medical charge even under the BMI. The analysis of people's medical charge under the BMI and the sharing situation; the systemization of factors of the influence & the deciding the individual rate in medical fee will produce strong reference value towards the evaluation of BMI, SMI's direction and the insurance level. This paper has checked the necessity of SMI establishment and the development space by revealing the different groups'medical fee under different medical methods, risk sharing and influence factors.This paper takes SMI as research object, after analyzing SMI in the provinces and cities of China. First of all, the paper analyzes how to localize the insurance range of SMI, realizing effective interface in insurance degree between SMI and BMI. Meanwhile, SMI range and insurance degree's designing should involve controlling reverse incentive, lessening moral hazard. The appropriate balance point should be discovered between the effective control of moral hazard and the insurance degree'stratified arrangement. Secondly, how we determine the rate and the financial method of SMI. By the SMI insurance degree, this paper offers the rate redetermination model under the normal operation of SMI fund, on the basis of which, determines the fee rate among government, enterprise and individual. Thirdly, how we design the SMI management model, integrate the resources between SMI's and BMI's management platforms. This paper produces the development direction of SMI and improves the SMI's implementation. The paper offers a series of plans in SMI and feasibility analysis for the government policy's promotion and making by analyzing market demand and supply in SMI, considering efficiency and justice.