The Research On Social Health Insurance Payment For Shenyang Urban Employees

As the essential component of social security system, social health insurance plays an important role on guaranteeing workers health and resisting economic risks caused by disease.In rencent years, with the improvement of health clinic, how to deal with the rapid growth of medical expenses has become the most important and urgent policy of the health insurance system construction in most countries. Health insurance system should ensure participant’s health effectively.On the other hand, it also demands to keep the health insurance expenditure within an acceptable range, keeps the balance between fund’s revenue and expenditure, avoids financial crisis, so as to affect sustainability of health insurance system and participants’health.Health insurance payment is an important part and an effective way to achieve the security function.In 2001 Shenyang City established a health insurance system for urban employees, after 10 years of operation, it has made some achievements, but "heavy cost" is still a strong problem reflecting serious livelihood of urban resident.One major reason is the unscientific payment mechanism, medical insurance paid by service incentive-induced demand for medical insurance agencies act, resulting in a huge waste of medical resources.In this paper, the results of existing research and relevant theoretical generalization, as well as the comparative study of different health insurance payment are the foundation stone of research.Through the induction and evaluation of Shenyang existing urban employees health insurance payment policies, and empirical analysis of medical fund revenues and expenditures, health guarantee, the burden of personal medical expenses, pointing out that the current Shenyang urban employees health insurance payment mechanisms exists"the high cost", personal issues heavy burdens such problems.With the successful payment experience of home and abroad, find the law and put forward comprehensive medical insurance proposal for Shenyang urban employees payment system.Finally, put forward Shenyang health insurance payment reform idea, namely of based on the total amount of advances to implement a system mixed pay-by diseases payment method.