Study On The Baseline Equality Of Medical Security System On The Goal Of Universal Coverage

Objectives:In the context of the universal medical insurance, this study theoreticallydiscusses the baseline equality of the basic medical insurance system, in order toprovide the theoretical support for the realization of the goal of the universal medicalinsurance and its sustainable development; it evaluates the achievement of baselineequality in the basic medical insurance system and analyzes the political influentialfor the formation of inequality by comparing the system designs and operation effectsof the urban workers' basic medical insurance, the social medical insurance for urbanresidents and the new rural cooperative medical system. On the base of case analysisfrom the typical areas, explores the protective factors that contribute to realize thebaseline equality; and then puts forwards the implementation strategies to achieve thegoal of the universal medical insurance directed to baseline equality.Methods:The baseline compensation levels of the medical system were measured by usingthe tool of household catastrophic health expenditure; the achievement of baselineequality in the system were evaluated and the institutional reasons due to systemeticdifferences were founded by comparing the multi-systems and using Shar kanskymodel to conduct the institutional analysis framework in the policy process theory.Data resources1. Literature retrieval was achieved by using the keywords as "the universalmedical insurance", "baseline equality", "medical insurance (security)" and "equality"in the Chinese Database, foreign language database as well as the other related sites,the three basic medical insurance policy documents and relative supportingdocuments were collected at the same time.2. Data collection in Z city and S city on site. Including: (1) Policy documents of the basic medical insurance system(2) Information on first page of illness cases of the insured people in themanagement database of the medical insurance.In Z city, information on first page of 7354 hospital records of patients who areeither urban workers or residents was collected in 14 appointed medical institutionsfrom December 2007 to March 2008. After the disease frequency analysis, this studychooses the information of 920 patients who suffer from coronary heart disease (theICD10 code is I25.101).In S city, patients information on first page of 2104 hospital records werecollected in 59 appointed medical institutions from June 2008 to December2008.These patients suffer from mixed hemorrhoids( the ICD10 code is I84.102) andare urban workers, urban residents or labor workers.3. Other resources(1) China Statistical Yearbook (2008), National Economic and SocialDevelopment (2001-2008), Analysis Report of National Health Services Survey in2003 and the initial results of National Health Services Survey in 2008 (published).(2) The report on the comparison of the three medical insurance systems fromthe Office of Labor and Social Security Insurance Agency in Hubei Province(unpublished).Data Analysis Methods:The descriptive analysis (calculated by means and standard deviation) wasconducted to analyze the hospitalization expenses, self-affording fees andhospitalization days; the single factor analysis (t test and ANOVA) was conducted toanalyze the cost information and the hospitalization days in different medicalinsurance systems; the Chi-square test and correspondence analysis were conducted toanalyze the medical distribution of patients in different systems. All the data wasanalyzed by using the professional statistical software of SPSS for Windows 12.0.Research Outcomes1. On the base of former research of the baseline equality theory; put forwardthree requirements and the concrete standard which can be used to evaluate thebaseline equality in basic medical security system: at first, equally subscribe toinsurance including both of the equal right and equal capability to subscribe insurance. It means, first, the medical insurance covers universal of people; second, the rate ofpersonal financing should take less the 50% of the total financing. Secondly, themedical insurance system should take the serious illness medical care as the basicgoal in basic medical service provide. Thirdly, the baseline standard of actual medicalcare compensation was caculated. Taken 10% as the critical value of catastrophicfamily pay, educed the baseline of the actual compensation rate is 55.22%, this valuein the rural area is 54.72%.2.After Comparing the basic medical insurance for urban employee(BMIUE),thebasic medical insurance for urban resident(BMIUR) and new rural cooperativemedical system (NCMS), we educed that the three systems are different in the target,financial levels and ways, the subject of financing ,treatment level ,etc. in the threesystems. Specific performance in (1) in the arrangement of the system, the threesystem capable covered the universal people, but the actual rate of subscribe intoinsurance is different, the BMIUE is 44.2%, BMIUR 12.5%, NCMS is 91.5%.on theresponsibility sharing issue, the burden on the personal financing of BMIUE isalbatross ,more than 50%. Whereas, in BMIUR and NCMS, the employer orgovernment take on the mean responsibility of financing, so the burden on private ismuch easier to take. (2)Three systems all provide the security to the serious illness,but not unity in clinical care. (3)The data from the Forth National Health ServiceSurvey suspect that the highest pay of inpatient is BMIUE(66.2%), second isBMIUR(49.2%), NCMS is the lowest, 34.6%.3. After the attribution analysis among the three systems, we could educe that, (1)the social background when the system was founded have great affection on thebaseline equality. (2)The dualistic structure of urban and rural blocks the developmentof medical care system in rural and urban area, which is also the reason of thebaseline inequitable. (3)The other reason of baseline inequitable is the bias of systemidea. The value of "efficient first" is used to guide medical care system, overemphasize financing responsibility, but not embody the idea of vertical equity infinancing.4. After analysing the basic medical insurance system in S city, we can educethat,(1)The coverage rate of basic medical insurance system in S city city reached94.28%. The urban resident and employee attended the same system, integrate medical system. (2)The difference of financing in the three systems is sharply.Employer take on the responsibility of financing for employee (incumbent andretirement) (3) Three systems provide the security to both of clinical and inpatient.Integrate medical insurance use the individual account, Inpatient and farmer workersuse clinical overall planning. (4)There are difference in health service utilize .theresult of DRGs tells that, the inpatient rate and average days of in-hospital of patientcovered by integrate insurance both higher than other two. (5)the averagehospitalization expense and overall planning account expenses of integrate health careis higher than inpatient health care and farmer worker health care ,but actualcompensate level is nearly equally .integrate medical insurance82.09%, inpatientmedical insurance 80.87%,famer worker medical insurance 73.28%,all of them higherthan the baseline compensate level of basic urban medical insurance 55.22%. theefficient of the farmer worker medical insurance is the highest,483.67, same issue onthe integrate medical insurance is 79.53.Conclusions1. On the goal of universal medical insurance, baseline equality means, theuniversal people in the country have the right and capability to be enrolled in basicmedical care. Besides, everyone could get a baseline security; the level of thisbaseline would not be different by the variety of people who attend into the system.2. The opportunity equality plays a great role in the achievement of baselineequality. Equal opportunity of health care subscribe require the people owns the sameright and capability to be enrolled in the health care. From the static aspect, the recentsystem arrangement have already considerate the different situation of the groups,make sure everybody could attend at least one health care. However, if consider thefluidity of the population, it comes the problem in implement.3. In order to avoid the catastrophic outcomes created from medical expenses,the basic medical care system with certain compensate function is considered as aneffective system. There is a specific misunderstanding among the three systems' goallocation ,that is over depend on the level in financing capability to locate the levelof security of system. It shouldn't taxis the security capability easily based onfinancing level.4. Actual compensate level of BMIUE have reached the baseline requirement, but the same issue on BMIUR and NCMS are lower, still not reach the baseline. Sothe differences among them are unreasonable, the baseline inequitable emerge in thewhole system, it needs to raise the level of BMIUR and NCMS as soon so possible.5. S city achieved high level baseline equality among the three systems which arevividly different in financing (1)There is no absolute effect of financing level tocompensate level, the exist financing difference is not the inevitable reason ofbaseline inequality in system. (2)There is discrepancy in financing among differentsystems, so the different support capabilities also exist in these systems. In order toavoid the system discrepancy forcing on private, keep the whole system's equity,choice can be made among different systems according to individual's own situationin some circumstances.6. The establishment of the concept and goal in the system was effected by thesocial environment. In order to achieve the universal medical care coverage on thebackground of harmony society construction, we should make sure the orientation ofbasic medical insurance system and rebuilt the concept of equality. The basic medicalinsurance system is not only a financing system, but also a social security system. Thefarewell and equality is its basic nature. The baseline equality concept is guideline.Including opportunity fairness on the level of medical service utilize and medical care,so as the vertical equality on financing issue.7. Based on the theoretical analysis and empirical research, put forward thestrategies for universal medical insurance stand on baseline equality as follows:(1) Reinforce the accessibility of medical insurance system; raise the coverage ofmedical insurance. Enlarge the methods of financing. Explore the other financingways like charity assistance, no tax loan fund, etc. explore flexible paymentmechanism. Optimize and simplify the process of attending insurance .reinforce thesupervision and motivation to the employer, raise its enthusiasm for attendinginsurance.(2) To consider individual identity as same. Explore the overall planning systembetween urban and rural .in the area where is no obvious difference between urbanand rural, should explore the overall planning of BMIUR and NCMS. In the goodeconomic development area, should explore the overall planning of BMIUE andBMIUR. (3) Reinforce the responsibility of government. Including the financingresponsibility for the rural and urban resident, shrink the distance to the urbanemployee. Also including reinforce government responsibility on protect justice ineconomic and society developing.(4) Construct the universal medical care system which stands on the baselineequality, fulfil the medical assistance system, and develop the supplement medicalinsurance and financial medical insurance.(5) Completely give play to the expense controller function of medical insurancesystem, lead people to seek medical service in basic medical institutions, decrease theunreasonable medical expense, raise the efficiency and the level of fund compensation,and improve the equality of basic medical insurance system.