Empirical Study On The Effects Of Integrating Urban And Rural Medical Insurance System In Changshu City

Objective:This study focused on analyzing the implementing condition and the effects of integrated basic medical insurance system in urban and rural areas in Changshu city and exploring the challenges in this process, aiming to provide some implications for the perfection of the basic medical insurance system.Contents:The theoretical basis of integrating basic medical insurance was classified and the environment of reform and the process of integrating the urban and rural medical insurance system in Changshu city get summarized; its effects were analyzed from four aspects of hospitals, the insured, the insurer and management system, and compared with that of other counties in Suzhou city and then the benefit equity of urban and rural residents was assessed; preconditions of integrating the basic medical insurance system in urban and rural areas were analyzed based on some international experience of universal health care; and policy recommendations for further improving the basic medical insurance system offered thereby.Methodology:1. Data source:(1)Literature review:CNKI, PUBMED and other databases, relevant network resources, like local health bureau, policy documents, and research reports etc.(2)Field survey:quantitative data was collected from questionnaire survey and related information systems,including operational data related to basic medical insurance for urban and rural residents in Changshu and the insured patients in two sample hospitals from2008to2010; qualitative data was collected from depth interview and group interview, and totally50people were interviewed.2. Methods:Four main analysis methods were adopted in the study, including literature review, Theil index, statistical analysis and qualitative analysis. Statistical analysis included chi-square test and variance analysis.Results:1. The age structure get optimized and the fund risk reduced as a result of integrating basic medical insurance system in urban and rural areas. The age structure get optimized along with the proportion of those aged over60decreased from46%to35.7%; and the fund utilization rate decreased to81.39%from113%thereby.2. By integrating basic medical insurance system in urban and rural areas, the influence of the administrative institution on medical institutions get enhanced, and the rapid growth of medical expenditure get contained. There was an annual decrease of5.59%in the average hospitalization expenses from2008to2010, while it increased by3.87%annually from2005to2007; the annual growth rate of the outpatient expenses decreased to0.09%from2008to2010, which was0.29%from2005to2007.3. It made patient flow reasonable through integrating basic medical insurance system in urban and rural areas, and both scale and equity of benefit get improved. Of the outpatients,64.3%took village clinics (community health stations) as their first choice; of the inpatients,58.2%preferred to township hospitals (community health service centers), and only3%of the inpatients sought treatment out of Changshu city; the scale of benefit was increasing, the equity of benefit was getting better, moreover, it appeared that the urban citizens, whose families may withstand more economic risks, helped the rural residents.Conclusions:1. Some preconditions are needed to integrate the basic medical insurance system in urban and rural areas. Firstly, economic development is important, but eliminating the income difference between the rural and the urban areas is not essential. Secondly, officials especially the main leader of local government plays a significant role. Thirdly, sound institutional settings are essential to integrate basic medical insurance system in urban and rural areas. Finally, the support of public opinion and the masses is needed.2. Along with the rapid development of economy and the community, the preliminary conditions is qualified for integrating the basic medical insurance system in urban and rural areas. 3. It’s helpful to develop and perfect the basic medical insurance system through integrating the urban and rural medical insurance system. Firstly, it’s helpful to consolidate and develop the basic medical insurance system. Secondly, it’s helpful to control the rapid growth of medical expenditure. Thirdly, it’s helpful to improve the managerial efficiency and avoid the double coverage of medical insurance schemes. Last but not the least, the scale and equity of benefit will get improved and the integration will benefit more to the vulnerable groups such as the rural residents.4. Advantages of medical insurance managed by health department initially appeared which will not only promote the coordinated development of the medical insurance system and the health service system, but also benefit the insured timely.Policy recommendations:1. Accelerating the integration of basic medical insurance for the urban and rural areas;2. Actively exploring to establish the effective and stable long-term financing growth mechanism and removing the gap from financing scale of urban employees’basic medical insurance and integrating basic medical insurance system;3. Further strengthening to control the growth of medical expenditure of contracted hospitals and reducing the risk of pool fund.4. Strengthening the policy advocacy and guiding the insured to seek treatments reasonably.