The Research Of The Urban Employee Medical Insurance For Outpatient Health Service

Objective:Current outpatient medical insurance policy mainly consists of general out-patient, outpatient chronic disease, specific outpatient projects, etc., this multi-account multi-level security model improves the participants'security level, but also increases the difficulty of health care sector's management and the venture of fund operation. The purpose of this study is to analyze current operating results of outpatient medical insurance policy, summarize the policy issues during the operation, and provide advice on the adjustment and improvement of outpatient medical insurance policy.Methods:This study adopted theoretical research combined with empirical analysis method. It summarized the theoretical foundation of outpatient medical insurance system design, and took outpatient security polices of basic medical insurance for urban workers in Nanjing as an example, conducted descriptive statistics of outpatient medical insurance policy operation, and adopted data envelopment analysis (DEA) to analyze the efficiency of outpatient medical insurance policy.Results:(1)population aging affects the sustainability of outpatient medical insurance policy; (2) fund expenditure of outpatient chronic disease and outpatient co-ordination medical insurance is increasing; (3) the insured tends to seek treatment in tertiary care institutions; (4) the boundary among the projects of outpatient medical insurance policy is not clear; (5) the design of outpatient health insurance policy is unsystematic; (6) the effect of outpatient medical insurance policy controlling hospitalization is limited; (6) the efficiency of outpatient medical insurance policy shows a decreasing trend.Conclusions:(1) the integration of outpatient medical insurance policy, specifically including the expansion of outpatient co-ordination, financing outpatient co-ordination alone and the determination of consolidated pay levels, and continuing to implement fixed administration in the aspect of management style. (2) the adjustment of outpatient payment policies, namely establishing compound pattens of payment for medical institutions of different levels. (3) the methods of improving the efficiency of outpatient medical insurance policy.