Empirical Study On The Differences In Medical Expenses Of The Insured In Chengdu Social Medical Insurance

In order to alleviate the medical burden of the general public, the state established a social medical insurance system, the system not only can make every person get the proper medical services, but also can protect the health rights of everyone.With the improvement of living standard, people generally begin to pay attention to health.The social health insurance system has developped for a long period of time, and has gradually become a diversified system.At present, China’s medical insurance system is composed by three parts,and they are the basic medical insurance for urban workers, the basic medical insurance for urban residents and the new rural cooperative medical insurance.The medical insurance system has basically achieved full coverage of the crowd in our country, but there is a certain difference between the different groups of people.From the current development situation of our country, the social health insurance system in different parts of the country is not the same.Each region provides different medical insurance to different groups. It caused lots of problems, such as the unreasonable medical insurance system. The difference in insurance treatment of various types of insured population is obvious. It may cause different groups of people forming a gap in the use of services and medical costs, so the actual role of social medical insurance can not be fully exerted. This paper is based on the differences of social medical insurance system in Chengdu, and specifically centre on the different groups of medical expenses. It also pay attention to the design, treatment level, service utilization and actual burden of medical insurance system in Chengdu. This paper mainly uses empirical research to evaluate the medical expenses and medical insurance system in Chengdu, and compares the differences in medical expenses of all kinds of people in Chengdu. Finally, it discusses the reason of the difference.According to comparative studies, the medical insurances of different people in Chengdu are so different, and the insurance treatment of urban workers is significantly higher than that of urban and rural residents.At the same time, data analysis shows that urban workers are higher than urban and rural residents in the use of medical services, and the insurance demand of urban and rural residents has been significantly inhibited, so their cost of medical expenses is far lower than that of urban workers. Based on the above research, this paper analyzes the unreasonable differences of medical expenses between urban workers and urban and rural residents in Chengdu, and explores the reasons behind the differences. Then, for the long-term development of social medical insurance system, this paper gives some suggestions on the development of Chengdu medical insurance system.Around the research object of this paper, the corresponding discussion is divided into five chapters.The first chapter is the introduction part. This part introduces the starting point, the significance of this study and the research status of domestic and foreign scholars on the medical expenses of the insured population and social medical insurance system.It also talks about how to arrange the research content and what are the methods used in the research of this paper.In the second chapter, the differences of social insurance system between the different insured groups in Chengdu were analyzed. First, this part briefly introduces the definition and characteristics of social medical insurance and the contents of the social medical insurance system in Chengdu.Besides, the social medical insurance system of the three insured people in Chengdu was compared, and we can find that the medical insurance systems of different insured population are different. This chapter has made a corresponding evaluation on reimbursement, financing and treatment level, the proportion of reimbursement,and it reveals that the differences in social medical insurance system may bring about the impact of medical expenses.In the third chapter, we can know the differences of medical expenses under the development of the social medical insurance system in Chengdu.This part uses the data of 2013 social medical insurance which is included in Chengdu medical insurance database system. First, The per capita medical expenses of outpatient and inpatient in Chengdu were analyzed and the results showed that the per capita medical expenses of inpatients were far more than that of outpatients. Besides, the per capita medical expenses of outpatient patients is too low, even the difference of high part is not obvious, so this chapter focuses on the analysis of the hospitalized patients in Chengdu. These patients are urban workers and urban and rural residents, at the same time, the details are analyzed, such as per capita medical expenses, basic medical care, the amount of self paid, etc. Through the comparison of the two types of hospitalized patients in Chengdu, the disparity of per capita medical expenses is too large. But there is not much difference between actual payment. So, This chapter analyses the two groups of people’s medical expenses, and groups the medical expenses according to age, gender, cancer and other factors. Then, the utilization of medical services in the two groups were analyzed, and the utilization includes the patient’s treatment choice, hospital days and the annual rate of hospitalization, etc. Finally, through the research and analysis, this chapter shows that reasonable medical expenses of urban and rural residents are greatly inhibited, and the utilization of medical services is far lower than that of urban workers.The fourth chapter is the empirical analysis, and it shows the difference of the medical expenses of the insured in Chengdu. The above is mainly uses descriptive analysis, so it will lose some information. This chapter analyses the factors which affect the medical expenses according to the data of 2013 social medical insurance in Chengdu. The empirical analysis uses the available detailed information, such as the patient’s age, gender, treatment mechanism, whether cancer, hospitalization days, the proportion of out of pocket etc. Each factor was judged by the regression results of the data, and based on the analysis, the reasons for the differences of medical expenses in different groups were analyzed.The fifth chapter is the conclusion and discussion. This chapter comes to the conclusion according to the research and analysis above, and analyses the medical service utilization of different people in Chengdu.The utilization of medical service is mainly related to the difference of medical expenses. It reveals the unfair of social insurance in Chengdu, and at the same time, the biggest institutional factor is the difference of the level of insurance treatment. The reasonable medical demand of the low level group was greatly inhibited. The medical service resources in Chengdu are overused by the high level group. In order to ensure the healthy development of the social insurance system, this chapter launches a discussion on the social medical insurance system of Chengdu.According to the process of this research, the contribution of the paper may be as follows:1.This paper applies the integration of theory with practice. It is an empirical study on the difference of medical expenses under the development of social insurance by using the field data. There is a big difference among different insurance groups due to their various social medical insurance systems, and there must be differences in service utilization and medical expenses. Foreign scholars have made some empirical analyses of the relevant medical services utilization, but the domestic researches only pay attention to the qualitative and normative analysis of the system. The researches on service utilization and expense differences remain in the level of speculation and reasoning, and it lacks of empirical researches.2.This article is based on the social medical insurance equity of 14 million people in Chengdu. According to the actual needs of the development of social medical insurance system in Chengdu, it provides the reference suggestions for the development of the social medical insurance system in Chengdu. Nowadays, China has clearly carried out the integration of social medical insurance system, but all regions are still in the stage to carry out pilot exploration, so there is no substantive progress. In this paper, we can know the large gap among different groups’ medical expenses, and it reveals the problems about the social medical insurance system in Chengdu. The conclusion of this paper has solved the puzzle of the development of social insurance in Chengdu, and provides a reference for the integration and development of the social medical insurance system.3.In this paper, the sample size of the object is large, and the stability is good, so the relevant conclusions are representative. The detail data of 2013 social medical insurance in Chengdu is classified and analyzed in this paper. The data is reliable and the sample size is large, so the related conclusion can reflect the operation situation of the social medical insurance system in Chengdu. It also can provide some reference values for other regions of the country.