Research On Problems And Countermeasures Of Medical Insurance System In Yangzhou City

In 2000, Yangzhou started to carry out the basic medical insurance system for urban employees, and then it began a pilot implementation of the basic medical insurance system for urban residents in 2007. The illness insurance for urban residents and for urban employees was taken separately in 2013 and 2015 by Yangzhou as a supplement of the basic medical insurance system. At present, Yangzhou has initially formed a multi-level, full coverage of urban population security medical insurance system. Due to the fast growing medical expenses and the increasing number of seriously illness patients, insufficient financial subsidies and relatively low level management, we see a negative balance of the serious illness relief fund account in the end of the year, and also problems of fraudulent insurance personal accounts, unclear cooperation accounts with commercial insurance companies and disputes of medical insurance verification.In addition, the different funding levels lead to a great different of benefits and reimbursement proportions for urban employees and urban residents. To define the current existing problems in urban medical insurance system and find out the causes, so as to establish a new system adopting both equity and efficiency, it has become an important topic to solve of the medical insurance system of Yangzhou.Methods of literature analysis, content analysis and comparative analysis are mainly adopted by this paper. Firstly, define the existing problems in the current insurance system of Yangzhou by intensive study. We find the problems like the different funding levels and guarantee benefits between medical insurance for urban employees and for urban residents; the loss of the medical insurance fund lead by the defects in design, development of medical insurance information system; relatively low benefits level because of the limited medical insurance fund coverage scope; staff in the medical insurance agency is less than enough to meet the growing demand for insured patients and also the insufficient financial subsidies from the government. Secondly, it compares the four mainstream medical insurance modes in foreign countries and analysis the advantages and disadvantages separately. And further, the medical insurance systems of domestic cities of Beijing, Shanghai and Shenzhen were taken as samples, because the systems in these three cities started early and enjoy high guarantee levels. This paper describes the current systems in these three cities and their histories then compares the differences in both the system and their histories. The characteristics are outstanding in the three systems. The paper reaches some conclusions then:the systems in the three cities all have some characteristics and advance practices that Yangzhou could learn from. Such as the establishment of outpatient co-ordination mechanism, and the system of medical insurance supervision, inspection of specific medical behavior, and also the interim measures of medical insurance system for urban employees and for urban residents. Last but not the least, this paper raises some suggestions after all the analysis above on how to improve the basic medical insurance system in our country:improving the medical insurance payment, and to establish a convergence mechanism for different medical insurance systems, introducing appropriate commercial insurance for medical insurance, set up a hierarchical medical systemnand making a more clear clarify of the roles that different government departs play.