A Study Of The Evaluation Of The Medical Insurance System Of WeiFang And The Measures Of Improvemnt

The reform of medical insurance system constitutes the important part of the social security system reform in China. How it goes is deeply related to the immediate interest of the masses and the social stability. Weifang witnessed the initiation of the medical insurance system reform for urban workers in 2001. This system has undergone substantial improvement and now it has covered the majority of urban workers after ten years'development. Although the insured workers enjoy the practical medical interest, some problems, real or latent, have arisen when the system is implemented, other relevant social problems ensuing. Therefore, the current system needs further improvement in more than one facet.An in-depth analysis is performed of the medical insurance system implemented in Weifang in terms of its premium level, the operation of the medical benefits fund, cost management, and social effect, using the theories of medical insurance, welfare economics, and health economics, among others. The thesis consists of six parts. The first part presets the theoretical orientation and practical significance of the study, reviews literatures in relevant studies, and sets forth the outline of the paper and the research methodology. The second part deals with the theories concerning the medical insurance with emphasis placed on dominant theories about evaluating medical insurance systems; moreover, there is an introduction of different modes of medical insurance adopted in foreign countries and a comparison is made between the systems of our country and those of the foreign countries. The third part is concerned with the aims, guidelines, evaluation method, and the setting of indicators of the evaluation system to be established of the performance of the medical insurance system. Also in this part an evaluation model is proposed with a system of positive indicators, negative indicators, neutral indicators and overall indicators related to the evaluation model. Additionally, the indicators are applied to the currently adopted medical insurance system to study its performance, which leads to a better understanding of the applicability and effect of the medical insurance system. The fourth part of the thesis is an evaluation and an analysis of the medical insurance system for urban workers currently implemented in Weifang with respect to the operation of medical benefits fund, expenditures of medical insurance premiums, and the overall performance of the medical insurance system. In the fifth part, the findings are presented of the analysis made of the medical insurance system in Weifang. They are comparative low level of premiums in the medical insurance system, no uniform standard of the premium, high risk of the medical benefits fund, low efficiency in using the medical benefits fund, and unreasonable allocation of medical resources. In the last part are the measures and recommendations to improve the medical insurance system in Weifang. Briefly, they are the extending of the coverage of the medical insurance system, the enhancing the government's responsibility, the strengthening of medical management to reduce cost, and boosting coordinated outpatient service under medical insurance system.