Research On The Function And Effect Of Social Medical Insurance Personal Account

The medical security system for urban workers,which combines the unified accounts with the public accounts,was highly praised by the society when it was founded.It is considered as a system innovation suitable for China's national conditions,and can effectively realize the smooth transition between labor insurance and public medical care.Nowadays,the discussion on the medical security system for urban workers is becoming more and more intense in society and academia.The key point of the discussion is whether the original intention of personal account is in line with the current development situation and how to reform the personal account system.The original intention of establishing personal account of basic medical insurance for urban workers is to form self-payment responsibility consciousness,self-accumulation and self-restraint,which not only meets the needs of outpatient medical expenses payment and copes with the challenges of aging population,but also achieves the purpose of controlling the expansion of medical expenses.However,the actual operation effect is contrary to the original intention of the policy.On the one hand,the medical insurance fund is a large number of idle personal accounts,on the other hand,the co-ordinated fund faces the risk of "bottom-up".Therefore,it is necessary to carry out theoretical and Empirical Analysis on the policy function of individual account of medical insurance in order to clarify the direction of reform.Firstly,based on the Grusman health demand model and Anderson health service utilization behavior model,this paper establishes the research hypothesis of the impact of personal account policy on the medical needs and medical expenses of insured persons.Secondly,according to the original intention of personal account policy,it analyses the restraint function and accumulation function of personal account.The connotation and effect are discussed.The restrictive factors affecting the function exertion and how to treat these two functions rationally are discussed.The goal of reform is put forward based on the function optimization.Through reflecting on the policy function of personal account,the analysis indicators of the operation effect of personal account in this study mainly include:(1)Evaluation of policy objectives;(2)Response analysis of policy reform.Investigation and analysis of insured people's satisfaction with personal account policy reform and community outpatient service security policy.According to the above evaluation indicators,this study takes Dongguan Medical Insurance Personal Account Policy in Guangdong Province as an example to analyze the operation effect of Medical Insurance Personal Account Policy.The data used are the data of Dongguan Employees' Medical Insurance Database from 2010 to 2016,and the sample questionnaire survey data of the insured employees in Dongguan.Firstly,using the statistical data of personal accounts of employees' medical insurance in Dongguan,this paper analyses the current situation of accumulation of personal accounts of employees' medical insurance,establishes the FE measurement model of the policy effect of personal accounts of employees' medical insurance in Dongguan,and focuses on the restrictive effect of personal accounts on medical insurance expenses.Secondly,through the analysis of the questionnaire data,the paper studies whether the insured people in Dongguan are satisfied with the current policy,whether they can reduce the medical burden of the insured,and whether the insured people are satisfied with the reform of diluting their personal accounts.Taking the operation of Dongguan Medical Insurance Personal Account as an example,this paper concludes that:1.Dongguan Medical Insurance Personal Account Reform has not reduced the accumulation of individual account funds.According to the statistics of medical insurance in Dongguan City,the balance of personal account of medical insurance is gradually increasing,and the amount of capital accumulation is large.2.The reform of Dongguan Medical Insurance Personal Account has not played a significant role in restraining medical expenses.Fixed-effect model was used to analyze the impact of personal account on medical expenses.The conclusions are as follows:(1)The policy of personal account in Dongguan has no significant restraint on personal medical expenses,medical insurance fund expenditure and total medical expenses.After introducing the policy dummy variable of the reform of personal account in 2013 into the model,it is found that the policy of personal account in Dongguan has no significant restraint on personal medical expenses,medical insurance fund expenditure The reform of personal account also failed to play a restraining role in controlling the rise of medical expenses.3.The rate of first-visit and graded diagnosis and treatment of the insured community in Dongguan City has increased.After the implementation of the new medical insurance policy,the implementation of the new medical insurance system has greatly alleviated the phenomenon of "large hospitals are piled up regardless of major or minor illnesses".The medical behavior of the insured in community first and graded diagnosis has increased significantly,and the willingness to hospitalize has decreased.4.Participants are more satisfied with the reform of personal account system.The survey results show that the insured people hold a positive attitude toward the policy of personal account of medical insurance,and they have a high degree of recognition for the policy design,policy implementation and service of designated medical institutions of the reform of personal account.5.The reform of medical insurance personal account needs to guarantee the outpatient medical needs of the insured.From the analysis of the factors influencing the satisfaction of the insured,the factors influencing the satisfaction of the insured with the reform of the personal account system of medical insurance mainly include: the medical conditions and technical level of the designated medical institutions in the community outpatient clinic,the service attitude of the designated medical institutions,the actual reimbursement ratio of the medical expenses in the outpatient clinic,and the system.Restrictions on the types of reimbursement and the scope of drugs,as well as the working ability and service attitude of the administrative agencies.It can be seen that the reform is not only the question of whether to cancel personal accounts,but also how to better protect the outpatient medical needs of the insured.Based on the above findings,this study concludes that the existing personal account system can not achieve the original policy objectives;while the reform in Dongguan has played a positive role in improving community first-visit and graded diagnosis and treatment,the burden of outpatient medical care of insured people has been significantly reduced,and their satisfaction with the reform is also high,however,the reform in Dongguan has played a positive role in improving community first-visit and graded diagnosis and treatment.The reform has not improved the idleness of personal account funds,the efficiency of personal account funds is still low,and it has not played a role in restraining the expansion of medical expenses.It is necessary to reform the personal account of medical insurance and establish a new and unified outpatient insurance system for the purpose of guaranteeing the demand of outpatient treatment.Because of the rigidity of the social security level and policy dependence,it is impossible for the reform to cancel the individual account outright.It needs to be reformed step by step from easy to difficult to reduce the change.The innovations of this paper are as follows: firstly,based on the original intention of the policy of personal account of medical insurance,i.e.accumulation mechanism and restraint mechanism,we have made a systematic theoretical analysis and empirical test on the function and operation effect of personal account of medical insurance;secondly,when using fixed-effect model to analyze the restraint effect of personal account of Dongguan,we introduce the time fictitious variable of policy reform and the ratio of personal account entry as tools.Variables are used to analyze the impact of individual account policy and its reform on medical insurance costs.Thirdly,in terms of research data,this study not only has the data of medical insurance fund revenue and expenditure from Dongguan Medical Insurance Database,but also has the data of questionnaire survey on the satisfaction of insurers.Combining the advantages of the two data,it systematically evaluates the effect of individual account policy and reform in this area,which is not in the existing research.The inadequacies of the study are as follows: 1.The empirical analysis of the effect of medical expense restraint does not control the patient's condition and severity.This has a certain impact on the results of the analysis of medical expenses,but in the comparative analysis of this paper,it does not affect the basic conclusions.Secondly,due to the limitation of available data,the study did not empirically analyze the pilot effect of completely canceling individual accounts,but based on economic theory analysis and problems in personal accounts,and proposed the reasons for phasing out personal accounts.