The Exploration Of The Serious Illness Insurance System For Urban And Rural Residents In Jiangsu Province

Objective:The construction of the medical security system in China has been effective, and has initially met the basic medical needs of the people. But the catastrophic spending on the home that the extra serious illness has still occurred. To this end, the arrangement of high medical expenses for the serious illness occurred in our country to further protect is implemented by the serious illness insurance system for urban and rural residents. The public sector and the private sector in the serious illness insurance system launch a series of cooperation, including the introduction of the Business insurance company management which improved efficiency. Analysis of the operation of serious illness insurance in urban and rural areas, according to the problems found in the policy research and the evaluation of the effects of proposed the development of public-private partnerships in China’s urban and rural residents a serious illness insurance proposal has practical significa.Methods:Based on definition of a serious illness insurance related concepts and public-private partnership theory, we do the case analysis to the typical regions in the implementation of a serious illness insurance system of our country, carding the cooperation of the public and private sectors, summed up the main forms of public-private cooperation in serious illness insurance system at the present stage.We collected serious illness insurance scheme and financing, reimbursement, operating conditions of 93 areas in Jiangsu Province and use the method of factor analysis on the overall areas to evaluated serious illness insurance operation.Results:Trend shows a wide range of public and private cooperation in the serious illness insurance of urban and rural residents, promoting the fine management of a serious illness insurance, but in the process of public-private cooperation, access and exit mechanism is not clear and need to the support of legal system and policy guidance. The evaluation index of the operation effect of the serious illness insurance is single. Research to the areas of Jiangsu Province indicated that the overall level of basic medical insurance is low and the merger of the system is not complete.Except that, the marginal is fuzzy, the handling of the main are complex so that the implementation of serious illness insurance caused by the pressure; serious illness insurance program of studies show that, regional co-ordination between Financing, treatment, protection of range difference, setting deductibles and piecewise reimbursement proportion has scientific problems which coused the development process of serious illness insurance not reasonable.In contracts of cooperation with the insurance company, the span of profit upper limit is large and parts of the contracts are lack of risk sharing and regulation mechanism. After descriptive analysis and factor analysis on the operation indexes of overall areas in Jiangsu Province, it can be found that difference between the regional co-ordination, the serious unbalance of financing, reimbursement and operation effect affect the equilibrium and persistent of system. The insurance company managers are different and the evaluation indexes need to be further improved.Conclusion:The situation of the typical areas and practical experience of areas in Jiangsu Province of serious illness insurance show that serious illness insurance can effectively reduce the population burden of disease prevalence, but in public private partnership, mainly with commercial insurance company’s cooperation, there still exist some problems. From the public-private partnership policy level and need to improve serious illness insurance of public and private sector cooperation in the basic theory research, balancing public and private sector interests diversification of cooperation, to build a legal framework for public-private cooperation of serious illness insurance. From the aspect of practical operation, serious illness insurance need to implement the overall level of high, alliance and coinsurance trial, making operation policy guidelines, specification of public-private cooperation process to establish illness insurance information collection and data monitoring system.