Research Of Health Care Security For Urban Residents: The Choice Of Model And Route

Due to a long period of reform, the Chinese public health insurance has spread its coverage, with over 180 million urban employees covered by Urban Employee Basic Medical Insurance (UEBMI), which was established in 1998, and about 700 million farmers benefiting from the New Rural Cooperation Medical System (NRCMS) that was reconstructed in 2003. But that's only a part of the whole population, many urban residents of informal sectors are not covered. So it's an urgent and significant task to establish a national health insurance system that will cover all the citizens. In order to achieve this goal, the Chinese government has tried, since 2007, to put into practice a new policy called Urban Residents Basic Medical Insurance (URBMI). The full implementation of the UEBMI, the NRCMS and the URBMI will constitute a national health insurance system that covers the whole population in China. Now there is a key question in front of us--how to fix the URBMI policy to perfect the Chinese national health insurance system? To answer this question and give some constructive advice is the aim and significance of this paper.This paper is based on the research of health care security for urban residents in China. The urban residents refer to the uncovered (or unorganized) by UEBMI in Chinese urban area, exactly including three types of people namely the children, the elderly, and the unemployed. The children include the primary, secondary, and high school students, infants as well as other under 18 years old. The elderly are limited to the population who are beyond the retirement age and without the security of UEBMI. The unemployed include the students who have not graduated from college or university, and other people who are at the working age without jobs.The research aims to find an appropriate model and specific route of health care financing for urban residents. In this goal, the framework of the paper is divided into four chapters.Chapter One is the preamble. In this part, the author introduces the background and significance of the research, and puts forward some important concepts and the object of this study. And then, the author gives a brief literature review in the same domain.Chapter Two is about the choice of model of health care security for urban residents. First of all, the author introduces the five typical models of health care financing in the world, and summarizes their features, the advantages and disadvantages. The analysis of each typical models aims to help our country find a better path to an appropriate health care financing system. Based on the actual conditions of our country and the experiences overseas, the author expresses an opinion that there are three models capable of solving the problems of health care security for urban residents. The three models are social health insurance (SHI), non-profit private health insurance (NPPHI), and voluntary community-based health insurance (CHI). However, it is not feasible to carry out the SHI or NPPHI in public health insurance for Chinese urban residents at present. The CHI is the best choice in reality.Chapter Three claims the realistic route and the system construction of health care financing for urban residents. This part will discuss what goals and principles should be set up for the system construction, how to carry out the health care financing and set the insurance benefits, what pattern of payment and cost control should be taken, how the special groups of urban residents join in the health care system, how to strengthen the management and improve service, etc. Then the author summarizes several types of implementation of UEBMI based on the comparative analysis of policies, which are typical representatives carried out by different cities in China. We can assess these different implementations by the evaluation criteria including fairness, applicability, effectiveness and sustainability. The result shows that the route of social essential health insurance is of superiority in solving the problem of health care security for the informal sectors.Chapter Four gives some viewpoints about how to perfect the Chinese health care security system. Firstly, the health care security (or financing) system must be tied up with the medical and health system reform, especially the establishment of URBMI must be in possession of comprehensive network of city community health service system, strict gatekeeper of general practitioners system, and efficient health insurance information management system. Secondly, the author studies the portability of benefits of the different health care systems and answers the question how the beneficiary transfers between the UEBMI, the URBMI and the NRCMS. Thirdly, the author suggests that the government promulgate incentive policy for using the employees'Medical Saving Account in the UEBMI system to help their family members participate in the URBMI system. Finally, the author proposes that it will be beneficial for the health care security system by employing the health management, and it is urgent to establish the legal system for health care security in China.In brief, the author comes to the following conclusion. Firstly, the voluntary community-based health insurance is the realistic choice for solving the problem of health care security of urban residents in China, and its developmental direction will be the social health insurance. Secondly, the Urban Residents Basic Medical Insurance (URBMI) is one form of the voluntary community-based health insurance model, and its implementation could be diversified nationwide. Thirdly, as a solidarity policy in the public health insurance system, the URBMI is guided by government subsidies and based on voluntary participation of urban residents. Its financial mechanism is PAY-AS-YOU-GO without establishing Medical Saving Account for an individual or a whole family. The insurance fund is put into operation by territorial administration. Fourthly, in order to build a multi-level health care security in China, the non-profit private health insurance, which plays a very important role in the supplementary health insurance, must be strongly supported for development.