Study On The Problems And Countermeasures In The Implementation Of The Medical Insurance System For Urban Residents In Zhongshan City

Early in July 2007, the State Council issued the "Guo Fa [2007] No.20 file-" guidance on carrying out the pilot work on basic medical insurance for urban residents ", the document explicitly requested in the nationwide choose one or two city of conditional provinces to start the pilot work on basic medical insurance for urban residents, also clearly put forward the goal,2010 in the implementation of medical insurance for urban residents.2008 belong to the expansion of the pilot phase, the national pilot cities as of 2009 reached a significant effect of about 80%. To this end, at that time, the State Council, the pilot evaluation expert group for the basic medical insurance for urban residents in a series of basic medical insurance to carry out a comprehensive survey, the results obtained on this accounted for six. Accordingly, in April 2009, "on the comprehensive development of residents’basic medical insurance work notice" by the Ministry of Finance and the Ministry of human resources and social security, the two major departments jointly issued.At present, all over the country have been in accordance with the national unified deployment, basically established a system of medical insurance for urban residents, but the local in insurance for urban residents of the financial subsidy policy, urban medical aid system, fund payment policy, ordinary outpatient costs overall, medicine and medical treatment project evaluation approach, handling the management and service level of service agencies and other aspects is still uneven, there are a lot of problems. Author through in-depth research, to participate in the government sector policy seminar, a lot of access to analysis of the domestic and foreign data, collect relevant data, that our implementation of the basic medical insurance system for urban residents has the following important significance:first, to cope with the aging of the population and family pension function weakening of social problems; second, it is conducive to the realization of social fairness and justice; third, conducive to the realization of social basic public services equalization of urban and rural areas.Generally speaking, China’s urban residents medical insurance system of the basic structure of the framework and the specific operation mechanism has been basically formed, has been recognized by the broad masses of the people, and the development of the situation for the better. And in terms of specific patterns to covering the establishment of universal health insurance because at present our country still does not have strong financial capacity temporarily unable to realize, and it’s not possible to non practitioners implement large amount even is full of medical assistance. Therefore, combined with the China’s actual conditions can only choose to adapt to the urban residents medical insurance system, is through personal investment, the state financial subsidies supplemented, in the basic medical insurance system established for urban workers, take the form of social insurance to solve urban non practitioners basic problem of medical treatment, urban practitioners in the implementation of the special medical insurance system.Of course, the implementation of the basic medical insurance system for urban residents in China also has a certain feasibility. Because, on the one hand, the urban non employed residents this group as the urban residents medical insurance system covered object and rural residents have a strong similarity; on the other hand, the system design framework of the model of rural social medical insurance system and urban residents medical insurance system are basically the same.The Zhongshan in Guangdong Province as an example, Zhongshan City, the medical insurance for urban residents since its implementation, despite the certain result, but in the process of promoting the practical still exist some problems:the first is the part of the insured enthusiasm is low; the second is co ordinating fund revenue and expenditure problems; the third is the management mechanism of the medical insurance management mechanism is not perfect; the fourth is handling mechanism and a lack of service consciousness.In view of the above problems, analysis the reason mainly, the first is the reimbursement ratio is not high, reimbursement procedures cumbersome, the attraction of the insured is not high; second is the medical insurance fund collection methods is not perfect so that the medical insurance fund expenditure insufficient; the third is special staff medical insurance management is not perfect and the lack of daily inspection and management system of designated medical institutions. Fourth is the lack of professional knowledge and ability training institutions.These measures include:to increase the proportion of claims and simplify procedures for reimbursement to raise the premium appeal; through improve the collection measures and standardize the spending has strengthened overall fund management; improve the system and do a good job in the development planning and the establishment of the daily inspection and management system of designated medical institutions; strengthen the professional training of medical insurance management agency personnel to enhance the service capabilities.According to the causes of the above problems, this paper puts forward some specific countermeasures and suggestions to improve the medical insurance system for urban residents, in order to provide help for the implementation of the medical insurance system for urban residents in China.