Study On Critical Illness Insurance Of Urban And Rural Residents In Taiyuan City

The system of critical illness insurance for urban and rural inhabitants is a social insurance system based on basic medical insurance which provides reimbursement for the high medical expenses incurred by residents due to major diseases and is a further extension of the basic medical insurance guarantee function.In August 201 2,the National Development and Reform Commission,the Ministry of Health,the Ministry of Finance,the Ministry of Human Resources and Social Security,the Ministry of Civil Affairs and the China Insurance Regulatory Commission jointly issued the Guiding Opinions on Carrying Out the Urban and Rural Residents' Critical Illness Insurance.On November 16,2015,critical illness insurance started.Carrying out the serious illness insurance for urban and rural residents is of great significance to alleviating the burden of medical expenses for residents,alleviating the problem of poverty caused by illness,returning to poverty due to illness,constructing a multi-level medical security system and promoting the establishment of universal health care system.This article uses the method of literature research,questionnaire,quantitative analysis and qualitative analysis to study the medical insurance system of critical illness in Taiyuan.From the five aspects of the level of protection,the situation of insured,the benefit situation,the financing mechanism and the mode of contracting,the current Taiyuan critical illness insurance system is generally highly protected,which can greatly reduce the arising economic risks when the insured persons have serious illness.Those participating in the basic medical insurance for urban and rural residents are included in the coverage of the critical illness insurance for urban and rural residents.The number of insured persons suffering from critical illness insurance has been on an upward trend since 2015 and the number of beneficiaries has also risen.Funding for the critical illness insurance is allocated from urban and rural residents' basic medical insurance funds,and individuals no longer pay critical illness insurance premiums.Insured urban and rural residents,which can not afford premiums,Taiyuan municipal government will give medical assistance and financial subsidies for their personal contributions.Taiyuan medical insurance for diseases is undertaken by the Shanxi Branch of China People's Health Insurance Co.,Ltd.From the perspective of the payment situation in the past three years,commercial insurance institutions have played their advantages to a certain extent,which has reduced the pressure on participants to pay.Through the investigation and study,it is found that the overall level of critical insurance funds for urban and rural residents in Taiyuan is still relatively low and it is difficult to play a role of mutual aid.Insurance companies suffered losses,contrary to the principle of "protecting the interests of small profits".The high cost of management fees reflects the lack of relevant supervision.At the same time,according to the data of the questionnaire,the propaganda channels of the system are relatively simple,and the urban and rural residents have a low awareness of the critical illness insurance system.Satisfaction with the reimbursement system also needs to be improved.In response to the above problems,the paper makes a few suggestions to improve the problem of critical illness insurance.First of all,to improve the level of funds coordination and enhances the ability to resist risks and establish stable and sustained funding mechanism for critical illness insurance.Improve the bidding mechanism for critical illness insurance for urban and rural residents.Strengthen the auditing of cooperative commercial insurance companies,supervise and manage implementation of critical illness insurance and reduce the cost of administrative expenses.Increase the publicity of the critical illness insurance system in Taiyuan.Simplify reimbursement procedures to improve reimbursement efficiency.Enhance the professional ability of business insurance agencies.Through these studies,the purpose is to provide reference and basis for government departments to understand the situation and improve social security policies,so as to effectively play the role of critical illness insurance.