On The Fairness Of Basic Medical Insurance For Urban Residents

Urban residents’ basic medical insurance is a component part of the social medical insurance. Our country has established the urban residents’ basic medical insurance system in2007according to the state council’instruction on urban resident basic medical insurance pilots, which greatly expand the level of insurance coverage and achieved good effect. However, due to some complicated reasons, this system is unable to obtain the fairness for each independent person. This paper is based on the survey result of the urban residents basic medical insurance assess by the State Council expert group in2007, using stata statistical software to evaluation and test the basic medical insurance for urban residents system. The research method involves historical analysis and the welfare economics analysis, qualitative and quantitative analysis, comparative analysis and empirical analysis, theoretical study and data study method. Research is generally divided into three angles:system investigation, results investigation and the regression model.In the system inspection part, the paper selected Shaoxing, Chengdu, Baotou, Xiamen four cities, which include east, west, south and north of China, respectively from three dimensions:the coverage, guarantee content and guarantee degree, comparing about the content of urban residents’ basic medical insurance system. Study found that in the generally population coverage degree, the fairness of urban residents’ basic medical insurance has some difference, that is, the coverage degree in the south and east cities is higher than that in the north and west cities. It also esist unfair phenomenon based on the household registration category even if in the same city. In the protection of content, the scope of coverage and medical management system of four cities are generally the same. The mainlly difference is reflected in the pay cost standard, such as whether the payment standard is stipulated by the contributions or capture to expend scale, etc. In terms of security level, a better justice system is as follows. Firstly, make the start line, top line, and pay scale standard link to peopele’s income level. Secondly, make different pay scales according to different levels of medical institutions. Thirdly, make different payment proportion according to different medical expense. In this way, it could fully setisfy the need of residents at all income levels, to make the remaining of "consumers" and "producers" in the medical market minimum and in order to achieve sufficient residents’medical fairness.In results inspection part, the paper accordingly selected parallel data of Shaoxing, Chengdu, Xiamen, and Baotou, respectively, and analysis service access (service utilization degree), guarantee degree (out-of-pocket payments) and affordability (the proportion of medical expenses) three dimensions for data calculation. On the other hand, the paper selected the time series data from2007to2011to do research on the improvemet of fairness. As can be seen through the study, firstly, the access degree of hospital medical service is superior to that of outpatient medical services. Secondly, the fairness degrees on the four cities are being improving year by year. Thirdly, compared with the data which in the second chapter, there did exsited some correlation in chapter2and chapter3, but it is not a linear positive correlation. The reason may be that the implementation of the institution could be affected by some local factors.Due to the data in the first part and second part, the result was not a one-to-one positive correlation. Therefore, in the third part, the paper established a multiple linear regressio model to explain the influence factors on fairness, which is based on the data in Chengdu. The dependent variable is the access of hospital medical service, and the explanatory variables are pay scale, out-of-porket payments, age, and annual family income. Regression results showed that the access of health service, that is to say, the fairness, is negatively related to the pay scale and positively related to the out-of-porket payments and age. The income of the correlation is not obvious.Finally, the paper put out related policy suggestions to improve the fairness of the basic urban residents. The measures mainly included three aspects. First, government should renovate the system of health care and expand coverage to realize horizontal equity. Second, governmet may use the government dominance to optimize medical services to achieve vertical equity.Last but not least, government should make three-dimensional adjustment policy in view of the different residents’ affordability to establish a basic medical insurance as the core of the universal health care security system.