Outpatient Service As A Whole System Of Basic Medical Insurance For Urban Residents

Currently, the urban and rural medicare system composed of fundamental medicare ofcity employees, fundamenal medicare of city residents, and new-type rural cooperativemedicare has been established overall, and the goal to establish medicare to cover all peoplewill be achieved soon. However, the above three medicare systems all highlight to secure thehospitalization, while the security to outpatient is lackcking or deficient seriously. With regardto the medicare of city residents, not only the individual may take considerable burden foroutpatient service fee, but also it will impact the inititave of the residents to join the medicarewithout the security to general outpatient services, which is disadvantageous to expand thecoverage. Therefore, <the guiding opinion to develop trial for fundamental medicare of cityresidents> (document No.20) publicized by the state council in 2007 explicitly requirethat“the area with needed conditions to develop the exploration of outpatient pool”. InAugust of 2009, the Ministry of Human Resources and Social Security and other twoministries publicized < the guiding opinion to develop outpatient pool of the fundamentalmedicare of city residents> and put forward the specific requirements to develop outpatientpool of residents medicare.Seen from the practical layer, some areas explored to establish the outpatient pool so asto provide the guarantee for general outpatient in some extent at the same time the residentsmedicare was established or later. But the ways in raising money,treatment，hospitalization，settlement,and management services are different in various areas.To summarize thepractical experiences in developing outpatient pool of various areas, and to promote theestablishment，development and improvement of city residents’outpatient pool, the authourstarted the research on the fundamental medicare outpatient pool of city residents，sorted outthe policies and relative research documents of the areas developed the residential medicareoutpatient pool,investigated deeply the fourteen cities---Shijiazhuan,Wuhu,Xiamen and Zibo,and so on，participated many proseminars about outpatient pool’s policies, colleceted relativedata of some area’s outpatient pool, and arrangeed and analized foreign practices andexperiences in outpatient security. The authour hope to exert own advantages that engaged in the improvement of socialsecurity of Zibo city, try to cite the theories in an appropriate way, analyze the issues clearly,and strive to have breakthrough and innovation in the policy suggestions sort of. Thereof, thisthesis plan to discuss the issues through the following technical route: first,analyze thesignificant of the outpatient pool, as well introduce briefly the foreign experences onoutpatient pool, next focus on the overall situtions of residnetial medicare outpatient pool allover the nation,especially make a comparative analysis on the five sample cities’practices andoperation situtions of residental medicare outpatient pool, discuss further the several mainissues in the executive process of outpatient pool as well, in the end, put forward the specificpolicy suggestions on developing city residental medicare outpatient pool.