A Study On The Approach To The Health Insurance Management Reform In China

Following national economy and social development,China's healthcare scheme is also facing new challenges along with new problems,such as increased healthcare demands,rising expenditure,inefficient healthcare management,unsecure healthcare fund etc.Starting from the status quo of China basic healthcare insurance management,this thesis analyzes the interests and conflicts of healthcare insurance shareholders,including the government,healthcare payer,healthcare provider and insuree,points out the existing problems such as healthcare insurance fund shortage because of increasing demand for healthcare and healthcare spending growth,inadequate healthcare resources usage,insufficient health management and inadequate coverage of medical insurance and growth in healthcare cost etc.Assessing the current status of basic medical insurance management in China through research and analysis,the framework of healthcare insurance information system in China has been established,however,the data standardization level is not high,data content is incomplete,and data quality is low.Maturity and perfection and precision of standardized healthcare insurance data/electronic medical record are still in progress.In addition,key performance indicators as the important appraisal tool of basic healthcare insurance are still needed strengthening.Firstly,about the causes of management problems,the major constraint is the low level of data standardization;secondly,the healthcare payer and healthcare provider are out of line;at last,due to lack of resources,shortage of staff,and internal mismanagement.To tackle these problems,the related government organizations should continue to move forward on healthcare scheme reform and management transform.Policies and regulations on this aspect need to be mended and implemented to serve the medical insurance scheme,healthcare system,public health service system,drug administration system in China.In addition,further efforts are needed to achieve the ultimate goal of providing affordable and high-efficient healthcare insurance for universal coverage in China.This paper attempts to find the approaches as follows,firstly,improve data quality,including,data collection,data processing and data mining,will lay the foundations for precision healthcare insurance management;secondly,improve government control,includes both policies and regulations improvement and personnel management strengthening;thirdly,one effective approach is to establish enterprise management,to improve healthcare insurance payer service capability and level through performance management,the other one is to introduce “Public-Private-Partnership” to achieve multichannel fundraising and optimize the use of outside resource;finally,in order to avoid actual expenses that exceed the budget,we should enhance the budget management and expenditure control.This paper not only covers the problems,challenges,and improvement strategies of healthcare insurance with change management activities in China,but also highlights the healthcare data quality improvement related solutions.