Research On The Financing And Reimbursement Condition Of Urban Social Health Insurance In China

China has been working to build universal coverage of social health insurance system, after 10 years of development, has initially established a medical security system with Chinese characteristics. This system now is a multi-level medical security, and the core is the social basic medical insurance. Urban population is covered by both the social basic medical insurance for urban workers and the one for urban residents. However, to achieve the goal of universal coverage, we can not help but ask:Although the policy has been achieved the entire coverage, but how about its implementation? In accordance with the current funding criteria, can they meet the actual needs of the people? Dose the system design to achieve a relatively balanced relationship between the current fund-raising and protection? Therefore, this article selects Shanghai, Chengdu, Neijiang, Mianyang as the example of this research. The research is based on field research, model calculations and results of comprehensive comparison. Major research focus on the following parameters:the level of funding in accordance with actuarial theory; the level of funding in accordance with current policy the existing level of funding; the level of protection according to the present funding; in accordance with current policy, the actual percentage of compensation, and the relationship of all these levels are reflected. Based on the ideas, this paper is structured as follows:ChapterⅠ:Introduction. Through the development of health insurance, the author leads to issues about the problem under the coverage, the purpose and significance of this article. And then this chapter shows the research contents and methods.ChapterⅡ:China's urban basic medical insurance, financing and security level analysis. This chapter is mainly on China's current medical insurance system for urban workers and residents. The basic medical insurance for urban workers has the characteristics of both SHI model and MSA model (The introduction of personal accounts on the base of SHI). The basic medical insurance for urban residents in the early stages of development adheres to the principle of voluntary participation (the community cooperative medical insurance model characterized).ChapterⅢ:The basic medical insurance for urban workers, the level of funding and security analysis. The focus of this chapter is the use of actuarial models and policies on the base of a large number of data. Through the comparison between Shanghai and Chengdu, the comparison between Chengdu, Neijiang and Mianyang, it can be found that in various regions of the system, the difference does exist.In accordance with the principle of balance of payments, funding level should correspond to the same level of protection. The current reimbursement system is obviously not enough. The program has some efficiency problem.ChapterⅣ:Funding of basic medical insurance for urban residents and the security level analysis. Finally found that the largest problem exists between the low level of funding and higher security needs. The level of funding under the current policy is equivalent to compensation ratio of 20-30% of the actuarial level, while the current level is between 60%-70%.The principal innovation of this article:Through literature review, I found that many studies are directed at the financing of the basic medical insurance or the level of protection imposed, while few studies work on the combination of them. The in-and-out balance is the basis for insurance plans to run, thus, from this perspective, this article will concentrate on this issue. In addition, the current policy reforms focused on reducing the burden on the insured and raising the level of compensation. Based on the current situation, the author personally carried out field surveys to collect first-hand data, carried out original theoretical research and validation.The shortcoming of this paper is:The author lacks the long-term work experience in the basic social medical insurance, can only be more of a study from a theoretical point of view. At the same time, due to differences in local economic and social aspects, the number of sample selection and the quantity of the sample should reach a higher level. However, for the objective conditions, they have failed to meet the highest requirements. It set some constraints to the article's result.