The Study On The Operation Mechasim Of The Insurance Of Urban And Rural Residents In Shanxi Province

After more than ten years of reforms and development,China's medical security system has achieved outstanding results.Basic medical insurance has been established as the mainstay,supplemented by a variety of supplementary medical insurance and commercial health insurance,covering a multi-tiered medical security system for both urban and rural residents.However,the level of basic medical care in our country is still relatively low,and the problem of “reducing poverty due to illness and returning to poverty due to illness” is more prominent.In this context,China proposed to carry out serious illness insurance,and made clear requirements for the principle of the development of major illness insurance,the funding mechanism,the scope of coverage,and the method of underwriting.All localities throughout the country carry out serious illness insurance work.By the end of 2017,serious illness insurance has covered more than 1 billion urban and rural residents.The accumulated compensation funds for the year have exceeded 30 billion yuan.The actual reimbursement rate for hospitalization expenses for patients with major illnesses is about 70% in the national average,and the number of people who benefit is about 17 million,which is nearly 6million times more than in 2016.Urban and rural residents disease insurance is based on basic medical insurance to reimburse patients with major diseases.Together with basic medical insurance and other supplementary medical insurance,it constitutes a multi-level medical security system covering urban and rural residents.The implementation of urban and rural residents disease insurance is the implementation of the new medical reform.The plan to improve the people's livelihood project of the residents' protection level is conducive to the formation of a multi-level medical security system that integrates and promotes each other.Since the development of major illness insurance for urban and rural residents in China,considerable progress has been made,but we must also see many problems in the development process.This article gives a brief introduction to the status quo ofChina's implementation of major illness insurance,sorts out the policy of serious illness insurance for urban and rural residents in Shanxi Province,and analyzes the development of serious illness insurance for urban and rural residents in Shanxi from the perspective of the operation mechanism of urban and rural residents' serious illness insurance,and the funding mechanism for serious illness insurance for urban and rural residents.The current situation of major illness insurance in Shanxi Province was introduced in four aspects: the operation mechanism,the protection mechanism,and the supervision mechanism.Through the analysis of the status quo,it was found that the major problems in the operation of urban and rural residents' serious illness insurance include narrow financing channels and low level of overall planning.There are many reasons for the existence of serious illness insurance operation mechanism in Shanxi Province.The insufficiency of serious disease insurance financing mechanism leads to limited financing channels and low level of fundraising;Fragmented basic medical insurance system and poor information communication restrict the improvement of critical illness insurance coordination level.The absence of risk management and control leads to a low level of risk control;the backward supporting services related to major illness insurance have affected the level of management services provided by the business and insurance organizations.In order to solve the problems existing in the operation mechanism of serious illness insurance for urban and rural residents,it is necessary to give full play to the role of the government,society,and undertaking agencies,and expand the financing channels,increase the level of overall planning,establish incentive mechanisms,improve the risk management and control mechanisms,and increase the specialization of contractors.We will improve the operating mechanism for serious illness insurance for urban and rural residents and promote the stable and sustained development of serious illness insurance for urban and rural residents in Shanxi Province.