Research On The Relationship Between The New Rural Cooperative Medical Compensation Mechanism And The Level Of Benefit Based On The Loss Distribution

The New Rural Cooperative Medical System is one of the important Social Health Insurance. "The Five Major Work for 2011 in Health System Reform" requires the compensation ratio of hospital charges in policy area reaches to 70%, and the cap line raise to more than 6 times as the per capita net income of farmers. In the background of adjusting the compensation mechanism constantly to raise the level of benefit, it's necessary for us to research the relationship between the compensation mechanism and the level of benefit by using scientific method of analysis. The level of benefit is reacted by the actual compensation ratio and the actual beneficiaries.If we want to study the relationship between the compensation mechanism and the level of benefit, we need to know the loss distribution of the New Rural Cooperative Medical System first. By using the principles and methods of non-life insurance actuarial, we fit the loss distribution of hospital charges of City D in 2009. The results show that the distribution of the frequency of hospital subjects to the Negative Binomial Distribution, and the distribution of the hospital costs uses the Segment Model, which is solved the description of the loss on costs well. This paper also proposes the method of predicting the loss distribution in future. Than, we establish the Analytical Model based on the loss distribution, discusses the relationship between the deductible, the cap line, the coinsurance percentage with the level of benefit, and the influence of the different compensation programs to the level of benefit, to reveal the relationship between the compensation mechanism and the level of benefit. Study found that with the drop of the deductible, the loss distribution will change. And the influence to the individuals is significantly higher than the overall. The raise of the cap line is not significant to the level of benefit in the present case of the loss distribution. But it should be noted that if the lost distribution changes some day, the ongoing raise of the cap line now will have a significant impact to the balance of the fund in the future. The coinsurance percentage has main impact on the compensation and the utilization of the fund, but has no impact on the beneficiaries. And in the reality, the actual compensation ratio is lower than the integrated compensation ratio. Lastly, according to the research above, the main conclusions and solutions to improve the system are given, including increase the level of funding, establish the Actuarial System, improve the Information Systems, etc.