The Operating Mechanism Of The Critical Illness Insurance In Shanxi Province

The Critical Illness Insurance of Urban and Rural Residents(CII)in China belongs to the social medical insurance system,which is a non-basic medical insurance system based on the needs of the people with critical diseases that cause their families' financial difficulties.Under the background of Health and Medical Assistance Program for Poverty Alleviation(HMAPPA)and the theoretical guidance of Quasi-public Goods Supply,Welfare Pluralism and Feasible Capacity,CII has been undertook by commercial insurance companies,and is an organic combination of government and market mechanism.In 2013,Shanxi Province launched a pilot project for CII,and then was officially implemented throughout the province in 2015.In 2017,all poor families with the Files and Cards have been listed as the medical support object of CII.Now the number of people insured for CII and basic medical insurance in Shanxi are basically the same.CII has provided sufficient medical risk protection for urban and rural residents,and solved the "the difficulty of seeing doctors and expensive medicines" for the poor rural population.In order to ensure the reliability of the research on the operation mechanism of CII,this paper collects the relevant literature on CII and HMAPPA at home and abroad,and grasps the first-hand information about the operation of CII in Shanxi through field study on the related departments and companies.This paper introduces the operating parameters and structure of CII in detail from the perspective of HMAPPA,and predicts the future income and expenditure of the major undertaking institution's CII fund through empirical research.After sorting out a large number of data and information,it is found that there are many problems in CII fund's sustainability,security and co-ordination,with CII operation of related companies.Based on Quasi-public Goods Theory and deduction of income and expenditure formula,this paper analyzes the causes of problems in CII and health service.In view of the problems above,and combined with the policy requirement of HMAPPA,this paper puts forward the suggestions of perfecting the operation mechanism of CII in Shanxi,namely,optimizing the profit and loss regulatory mechanism of CII fund,constructing the whole process and sharing cost-control mechanism of the medical insurance,promoting the effective connection between themedical insurance and medical service,improving the level of settlement service and multi-party supervision,and realizing multiple financing and coordination of the medical security.