Risk Analysis And Control On Critical Illness Insurance Within New Rural Co-operative Medical System

From the initial free medical service to national health insurance, the medicalcare insurance system improving and developing constantly in our country. However,the basic medical care insurance currently still at low level, especially the answer tothe critical illness still not enough. The burdens of personal medical expenses stillheavy, the phenomenon of ‘disease causes poor’ and ‘disease causes poor formaffluence’still very popular. In order to improve the medical security system level ofurban and rural residents, Chinese Government published ‘The guidance of carryingout the critical illness insurance within urban and rural residents’ in2012. Tointroduce the critical illness insurance institution, relievecritical illness burdens overthe residents. At the same time, as a social manager, the insurance companies areinvolved in tide of medical and health reformation in our country.Critical illness insurance within urban and rural residents will be carried outacross the whole country. By means of comprehensively identify the risk factors andevaluate the risks scientifically, could let the managers understand the currentsituation that the critical illness insurance faced in the present stage and could givemanagers some significant guidance for modulating working mode which hasimportant significance to the steady operation of critical illness insurance.From previous literatures, we found that the mainfocused on issues of fundrisks and management models and paid less attentions to the comprehensive riskidentification and measurement. Standing in the position of insurance companies,the consideration risk factors may also be different. Therefore, this article aims atidentifying the influences of various risk factors of insurance companies operatingthe critical illness insurance, comprehensively. Then establish a risk evaluationsystem, try to use the risk measurement approach to evaluate the condition of trialoperation of new rural cooperative medical system (NCMS) in2013. During this era, the policy background supported by comprehensive riskmanagement theory. This article integrated the Shandong Province’s NCMS data of2013from PICC. We found the reflected problems of the operation work and thedata, preliminary identified the inner and outer risk factors of NCMS. To modify andsupplied the identified risk factor and established a new risk evaluation index system.When we did risk evaluation, we thought about that the NCMS has short operationtime.The risk data was not comprehensively clearand also the valid data in shortspan was difficult to do regression analysis. So, in this article we has usedAHP-fuzzy comprehensive evaluation model for risk evaluation. Firstly, we used theAHP for determining the index weigh and this thesis has adopted expert consultationmethod and invited college, healthy department, serious illness, insurancemanagement, department of insurance company and department of reimbursement inhospital. These four departments and twelve experts to rating for the survey. Thenwe used the fuzzy comprehensive evaluation to measure risk index value, ABCapproach to classify the evaluation result. We divided the index into three category,‘General Risk Factor’,‘Main Risk Factor’ and ‘Important Risk Factor’. The resultsuggested that the NCMS had some general risk, but still in control. From allindexes, the ‘Management by Politics (MBP)’ has the largest influence to NCMS,the next is ‘Medical Demand Risks’ and ‘Operations&Risk Management’.‘FundRisk’ had less influence to the whole risk. In the aspect of risk control, according tothe basic procedure and evaluation results, gave some suggestions to every risksubjects particularly.The evolution result could help the managers to understand the potential riskscomprehensively as comprehend to the risk of current situation and to provide somesuggestion for the risk control. Only we guarantee the fund security, control medicalneeds, strengthen the operation management and formulate critical illness policiesscientifically that could ensure the NCMS operating in security way, and let theresidents enjoy more medical benefits.