Research On The Optimum Premium Rate Of Basic Medical Insurance In China

Reform and improvement of social security institution is the objective request and inevitable trend about constructing the harmonious society of China. Social insurance institution is the core content in the social security system. Basic medical insurance is the very important part in social insurance institution. Therefore, it is very necessary to explore the basic medical insurance premium rate that belongs to social insurance scope. The increasing of China medical fees gradually can mainly contribute to the people's recognition to health, the appearing of population aging problem, the abroad using of high technological medical product, the change of disease infection mode and some shortcoming of medical insurance institution and so on. The urban resident's basic medical fees can be written off by the basic medical insurance institution mainly. The premium rate of basic medical insurance decides the medical fees that rural resident can be written off in some degree and contributes to limit some unreasonable medical consumption and fees, so it is necessary to study the premium rate of basic medical insurance.The present basic medical insurance institution of China still is not perfect, it is necessary to explore the intrinsic running law of basic medical insurance institution. The premium rate of basic medical insurance is the key variable to perfect the basic medical insurance institution, so there is inevitability to analyze the premium rate of basic medical insurance.The premium rate of basic medical insurance can not be too high or too low. Holding constant any other factors, too high premium rate of basic medical insurance will lead to low efficiency of resource allocation, but too low will not guarantee resident's basic medical security and not improve social welfare. So, it is necessary to research the optimum premium rate of basic medical insurance.Domestic and foreign scholars have not do much more deeply research on the optimum premium rate of basic medical insurance. Their research related to the optimum premium rate of basic medical insurance mainly focused on defining the basic medicare, the level of the basic medicare, the medical insurance system and moral hazard that related to the optimum premium rate of basic medical insurance. In general, foreign scholars'research with their own national medical institution in the background have the strong regional taste, what is more, culture and ideology have the strong effect to the research related to the medical institutional improvement. Domestic research and analysis emphasize particularly on qualitative description and policy drumbeating, there are few deeply theoretic quantitative research. There is almost no special research on the optimum premium rate of basic medical insurance of China.We will provide some exploring research based on above background.The research object of this essay is the China's urban optimum premium rate of basic medical insurance that belongs to the criterion mandated by government based on pay-as-you-go.Three theory including certainty equivalent and risk premium, adverse selection and moral hazard, maximum of total net social benefit constitutes the theoretic base of research related to the optimum premium rate of basic medical insurance.Premium rate of basic medical insurance refers to the proportion between premiums of basic medical insurance that policyholder namely insurant pays and his or her wage in one period (generally a month). Essentially, the optimum premium rate of basic medical insurance should adapt to the basic function of basic medical insurance. The basic function of basic medical insurance as follows: First, it must guarantee the residents'basic medical security. This is the optimum estimation to the premium rate of basic medical insurance from the demand aspect. Second, it must adapt to the economic development. This is the optimum estimation to the premium rate of basic medical insurance form the supply aspect. Third, it must contribute to the fully use and optimum allocation of resource. This is the optimum estimation to the premium rate of basic medical insurance from the economic efficiency. The premium rate of basic medical insurance related to national income redistribution system and labor force demand and supply system directly, we should construct this model beginning with these two systems. On condition some of suppose, optimum premium rate model of basic medical insurance is:Here, G represents gross domestic product, H = M/G represents optimum level of basic medical insurance, B = W/G represents optimum coefficient of labor factor allocation.The optimum premium rate of basic medical insurance determined by the optimum level of basic medical insurance and optimum coefficient of labor factor allocation, it is the division between optimum level of basic medical insurance and optimum coefficient of labor factor allocation. So, form the logistic relation of model, every parameter that affects the level of basic medical insurance and coefficient of labor force allocation will be supposed. According optimum premium rate model of basic medical insurance, the optimum premium rate can be estimated and the optimum premium rate corresponding to one kind of different population can be analyzed.The optimality on the present premium rate of basic medical insurance can be analyzed based on the estimation to the optimum premium rate by model. The present premium rate of basic medical insurance is lower than the big caliber optimum premium rate nominally. According the institutional arrangement of present basic medical insurance institution and present retired institution, the present premium rate of basic medical insurance is equal to the small caliber optimum premium rate actually in general. In order to make the premium rate develop optimally, the present premium rate of basic medical insurance can join with the big caliber optimum premium rate or the small caliber optimum premium rate.Analysis of improving countermeasure to basic medical insurance institution based on the optimum premium rate includes discussion on the paying entity of basic medical insurance, existence of individual account and determination of basic medical outpatient fees, demanding aspect control to basic medical inpatient fees. The analysis about the relation between the paying entity of basic medical insurance and labor force market and product market indicate that employer pays premium of basic medical insurance do not have essential influence to enterprise cost and profit. In order to decrease the transactional cost because of the dynamic adjustment of optimum premium rate of basic medical insurance, the present method that how the premium proportion of basic medical insurance divided between employer and employee can be used to divide the optimum premium rate. The present mode of basic medical insurance named combination between individual account and social pooling appear some shortcomings, individual account should be died down and abolish gradually. Deductible in inpatient basic medical insurance should be abolished. After that, the former functions of deductible can be realized by adjusting the coinsurance rate fully. Social optimum coinsurance rate of basic medical insurance can be determined by weighted average to optimum coinsurance rate of every representative patient. On the basis of that, the determination of coinsurance rate of basic medical inpatient fees can decrease from 25% to 0% with the medical fees increase. According to the institutional arrangement of present basic medical insurance of China, basic medical inpatient fees can be recognized approximately from 0 to 4 times of average wage. Thus, coinsurance rate can be divided into subsection from 25% to 0% according to basic medical inpatient fees. The caps line of basic medical inpatient fees should be abolished on the basis of determining coinsurance rate reasonably.System reform of division between treatment and selling medicine, paying method of basic medical fees, developing community health services vigorously, governmental sanitary input reform, nurturance contributing to health lifestyle become the assisting reform measure based on the optimum premium rate of basic medical insurance. There are two kinds of methods to divide the treatment and selling medicine as follows: State enact a law to forbid hospital to sell medicine, hospital only have the treatment duty to patient. The present drugstore of hospital can be managed by corporate that produce medicine. Another method to divide the treatment and selling medicine is the medicine can be rationed to every hospital after the governmental sanitary department buys the medicine by bid for hospital. Every hospital will be forbid to make a profit because of selling medicine. There are two paths can be chose for paying method reform of basic medical fees. First, paying method reform of basic medical fees can change from fee-for-service to global budget. Second, vertical integration named employee mode or network mode can be implemented between administrative institute of basic medical insurance and basic medicare providers. There is much active significance to develop community services vigorously. Nowadays, the notion of community health services should be innovated, the desirable fundraising mechanism should be established, the human resource troop should be strengthen, the quality of community health service should be improved in order to realize its sustainable development. Governmental sanitary input reform should insist on a basic trend named optimum input, transiting structure and improving efficiency. At the same time, it is necessary to regulate the present financial structure according to the request to the public finance-reforming trend in order to give financial support to this reform adamantly. Form the personal aspect, there is the very important significance to prevent disease, decrease the heavy degree of disease and control medical fees because of nurturance called contribute to health lifestyle. Health lifestyle mainly includes arrangement of desirable meal, insistence on adequate sports, changing the bad behavior, holding on mild attitude and learning of health knowledge etc.