Outpatient Service In The Insurance For Medical Care For Urban Residents

Since the establishment of Medical Insurance System with Chinese characteristics in1998, Chinahas preliminarily built the "Three Vertical and Three Horizontal"---a fully-covered and multi-level healthinsurance framework, which has accomplished the achievements of starting from scratch, an increasingcoverage, and the benefit level from low to high. For a period of time to come, China’s Medical InsuranceSystem will grow gradually towards the direction of connotive development, and the single model of“medical insurance only for serious disease” will be transformed into the development stage of “overallconsideration to both minor illness and serious disease”. In addition, along with the significant changes indisease spectrum, Chronic diseases will increase in the cost of medical treatment and the growing burden ofresidents in outpatient, government and people of the medical insurance system have a higher level ofdevelopment requirements, the development of out-patient co-ordination has become a consensus.Since the implementment of the out-patient co-ordination system in the basic medical insurancefor urban residents in2007, the system has been spread rapidly. Outpatient co-ordination is graduallycoming into the field of research. At present our country scholars on out-patient co-ordinate more research,in theory, based on the practice of not more than. Therefore this article attempts use a combination ofliterature and empirical research methods from practice base, selecting the pilot city out-patient co-ordinatesystem as the research object to analysis the operation status, from the implementation modalities of theoutpatient co-ordination in different places, mode of financing, treatment level, payment policies andsettlement methods, medical care management, and put forward my own thoughts which based on therunning status.From a practical point of view,98percent of regions around the country have carried out theoutpatient co-ordination by2011, and the Medicare outpatient co-ordination for residents has achievedgreat effectiveness. Nevertheless, numerous hidden cruxes exist in practical work. After sorting the currentsituation of the implementation of the outpatient co-ordination, the thesis summarized and confirmed theachievements of outpatient co-ordination. In addition offered a detailed analysis of the problems during theoperation of the outpatient co-ordination from within and across regimes respectively, and probed into thecause of the problem. The development of Residents Medicare outpatient co-ordinating has a long way to go. Any goodexperience of the pilot process, we can learn and study, so the article selected some cities which have goodpractices in the outpatient co-ordinate the pilot cities to learn from as a typical regional experience. At theend of this paper the future residents health care out-patient co-ordinate system development puts forwardsome thoughts. On one hand, the development of the Resident Medicare Outpatient Co-ordination needs tolearn from the advanced experience of good practices from around. On the other hand, we also need tojointly combine the financing policy, payment policy, payment handling service capacity, the negotiationmechanism, the mobilization capacity of primary health care services, good top-level design, and perfectthe supporting policies to promote the smooth progress of the outpatient co-ordination.