| Background and Purpose As an important part of health system,health insurance system plays an important role in preventing the economic risk of disease and protecting public health.After decades of reform,China has built a high coverage of the basic health insurance system,which is composed of the New Rural Cooperative Medical Insurance System,Medical Insurance for Urban Residents and Medical Insurance for Urban Workers.However,there are still some issues such as management system fragmentation,lack of sustainable financing mechanism,poor risk sharing ability in health insurance system.There is a certain gap from the goal of universal health coverage.This study was designed to systematic review and evaluation on the existing problems of China’s health insurance system,screening the priority intervention goals for universal health coverage,analysis the key points of the next health insurance reform,and then constructs the Pro Model simulation computer model based on the priority reform goals,do some policy adjustment experiments,which proposed to provide theoretical and practical evidence for health insurance reform in China.MethodsIn this study,we used the self-designed questionnaire for the diagnosis of the existing problems of China’s universal health coverage and the screening of the priority goals.Used convenience sampling method,extracting 1650 cases from hospitals,universities,health administrative departments,social security institutions and other medical insurance business departments in Heilongjiang province,Zhejiang province,Chongqing,Beijing as its questionnaire.Grey relational comprehensive evaluation method was used for evaluation on the existing problems of China’s health insurance system and factor analysis method was used to establish the priority of universal health coverage.The official data of 2008-2014 were collected from the national health services survey,China Statistical Yearbook,China Health Yearbook,the Web of China statistical information,China and Heilongjiang provincial health health and family planning commission.The simulation model of Pro Model was used to build the model of universal health coverage which based on the priority goal,and validated the model,conduct predictive analysis and policy adjustment experiments.The auxiliary data software used in the research mainly includes Excel2010,SPSS 22.0 and Pro Model simulation software Student Edition.Results1.On the basis of clarify the core concept of China’s universal health insurance system.That the universal health insurance is a country inorder to prevent diseases and health risks,protect the health of citizens rights and establishment of the multi set of institutional arrangements and objectives as a whole,by all citizens enjoy the same benefits of design standard and service pack system,a kind of institutional arrangements to achieve equitable health services,and protection and economic ability etc.target.This study constructed six core elements include the same benefit standard,equitable benefit,economic risk protection,accessibility,mdeicare coverage and the crowd covered.2.The realization of universal health coverage was relatively low in current and the satisfaction was also poor.The results of grey correlation comprehensive evaluation showed that the design of compensation mechanism and the convergence of health care,health insurance and medicine,the design of financing,the design of welfare package.3.The goals of universal health coverage were sustainable development of universal health coverage,fairness and economic protection(the variance contribution rates were21.685%、17.231% and 15.788% respectively).Sustainable development was the most important goal.The specific goals which had more factors loading were as follows: to achieve the balance of income and expenditure of medical insurance fund and ensure the sustainable use of medical insurance funds,to construct the dynamic adjustment mechanism of medical insurance system,to establish the connection between medical insurance system and the external social systems,to achieve the goal of balanced development of medical insurance financing and local economic,to achieve the orderly connection of each specific system within the health insurance system.The sustainable development of medical insurance fund should be the primary goal of universal health coverage.4.Since 2008,the coverage of basic medical insurance system has been continuously improved,and the level of financing in NCMS and MIUR is raising and gradually consistent,the level of financing in MIUW is basically unchanged.MIUW has the highest level of reimbursement,the balance rate of medical insurance funds generally declined since 2010 in all three insurances.To construct the Pro Model simulation model based on the balance of revenue and expenditure of medical insurance fund.Through the analysis of fund flow in medical system and medical insurance system,policy fund flow and Pro Model simulation operation flow,then to establish model dependent variables and the function relationship between variables,to construct the logic process of the variables.Finally,the simulation model of medical insurance fund balance which based on ―medical insurance-medical service‖ was established.The data of Heilongjiang in 2014 were brought into the model,and the relative error rate between the results and the actual results was less than 10%,the model was verified to be effective.5.Forecast 5 years of the operation of the medical insurance fund for next 5years in accordance with the basic data of Heilongjiang province between 2010 to 2014.The total amount of medical insurance funds will be basically the same as the health insurance fund expenditures of NCMS and MIUR in 2017(1.39 billion of NCMS and 1.98 of MIUR),and the fund will make ends meet after 2018.Insurance fund of MIUW is also facing a shortfall risk in 2019,the medical insurance fund is facing a crisis of sustainable development.The results of experiment adjustment shows that enhancing financing standard of different medical insurance system,improve the hierarchical medical system(lower proportion in tertiary hoapitals,higher proportion in first and second level hospitals)will ensure the balance of insurance fund and raise fund balance rate at the same time.And this can be used to further improve the reimbursement ration of medicare reimbursement.ConclusionsHealth insurance system reform has made remarkable progress,but there were still exposed some problems.This study developed six core elements based on the evaluation of WHO’s three dimensions.According to the results of priority goals of universal health coverage and Pro Model simulation run forecast,the primary goal of universal health insurance reform is to balance the income and expenditure of insuance fund.The goal of the universal health insurance and the realization of the depth of the process is not only a single factor of the role,it needs a common effect of various factors.First,to promote the system reform among health care,health insurance and medicine,actively promote the establishment of hierarchical medical system and improve the ability of diagnosis and treatment of primary medical institutions in health service system combined with the reform of medical insurance system and medicine system at the same time so that to provide a good external and internal environment for the sustainable development of universal health coverage.To promote the reform of medical insurance financing design,to construct the stable dynamic medical insurance fund raising mechanism then to ensure the balance of income and expenditure,then to achieve sustainable development of the fund.To improve the design of the welfare package and compensation mechanism of medical insurance system,increase the reimbursement reasonable then to ensure the fairness and economic protection function. |
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