Study On The Operating Mechanism Of Serious Disease Insurance Fund For Urban And Rural Residents In Shandong Province

With the development of serious illness insurance for urban and rural residents in China,the economic burden on the patients with serious illness has been reduced to a certain extent,and the phenomenon of poverty caused by illness and returning to poverty due to illness has been effectively avoided.The aging of population and the diversity of disease spectrum in China are becoming more and more serious.The demand for disease insurance for urban and rural residents is further expanded,which has also become the focus of scholars' discussion.China's urban and rural residents' serious illness insurance started relatively late,compared with other social security systems,there are still institutional defects.In 2014,the Shandong provincial government issued two documents,"Opinions on Developing the Work of Resident Serious Disease Insurance" and "Implementation Plan of Resident Serious Disease Insurance Work",which marked the preliminary implementation of Shandong Resident Serious Disease Insurance System in an all-round way.In the process of popularization and practice of major illness insurance in Shandong Province,a series of problems such as low financing level,unclear compensation standard and imperfect supervision mechanism have gradually been exposed in the operation mechanism of major illness insurance fund.By using qualitative and quantitative analysis,combined with theoretical analysis and empirical analysis of scientific research methods,this paper analyzed and studied the operation mechanism of serious illness insurance for urban and rural residents in Shandong Province.Firstly,the connotation of serious illness insurance for urban and rural residents is explained,and the composition of the operation mechanism of serious illness insurance and its interrelationship are explained.Secondly,through the study of domestic and foreign major illness insurance system and operation mechanism of major illness insurance,the experience of other modes is summarized.Finally,the financing mechanism,operation mechanism and supervision mechanism of Shandong serious illness insurance fund are elaborated and analyzed in detail,and relevant suggestions and safeguards for improving the operation of serious illness insurance are put forward.Through analysis and research,the following main conclusions are drawn:(1)The operation of the major illness insurance fund is an organic whole with the main body of the major illness insurance fund and the functions of fund raising,compensation and supervision,which restricts each other and keeps balance.Establish a multi-channel financing mechanism,a scientific and reasonable compensation mechanism,an open and transparent regulatory mechanism,and form an effective coordinated development of the three aspects ofthe operation of the fund,so as to promote the sustainable development of the major illness insurance fund.(2)At present,the fund-raising mode of serious illness insurance in Shandong Province is to draw a certain proportion from the urban residents' medical insurance fund and the New Agricultural Cooperation Fund,which is in line with the actual situation.The government's responsibility runs through every link of the operation of the major illness insurance fund and plays a vital role in the development of the major illness insurance.At present,there are some problems in the financing mechanism,such as the low level of financing and the single financing channel.Therefore,it is very important to construct the financing mechanism of the major illness insurance fund scientifically.On the basis of implementing the current financing mechanism,it is necessary to gradually raise the financing standard,increase government subsidies,open individual payment authority,and allow social donations.(3)There are some problems in the compensation mechanism of serious illness insurance for urban and rural residents in Shandong Province,such as unreasonable compensation standard setting,low compensation level,and no sound compensation adjustment mechanism.In this regard,the ARIMA model is constructed to predict the balance of major illness insurance premium for urban and rural residents in Shandong Province.The forecasting results show that the balance of major illness insurance will continue to increase,and it is expected to reach280 million yuan in the first quarter of 2019,which indicates that Shandong Province has a better control of compensation for major illness insurance.The forecasting sequence chart shows that the growth rate of the balance of major illness insurance in the forecasting interval has slowed down significantly,which indicates that Shandong Province should strengthen the financing and control of major illness insurance fund in the future.We should make compensation for major illness insurance and improve the supervision of major illness insurance funds.(4)At present,the supervisory mechanism of the serious illness insurance fund for urban and rural residents in Shandong Province operates well,but there are still some problems,such as the imperfect legal system of supervision,the low degree of informatization,and the quality of managers to be improved.Some suggestions are put forward,such as improving the transparency of information about the operation of major illness insurance fund and improving the diversification of supervisors.