Study On The Implementation Of Critical Illness Insurance Policy For Urban And Rural Residents

For the purposes of reducing or preventing the people "falling into or/and falling back to poverty from the critical illness",the state council published the “Guidance for carrying out the Critical Illness Insurance for the Urban and Rural Residents” in 2012,which emphasized on the issue of the unaffordable costs for the critical illness.Then,the pilot project operated.Till now,the system of the critical illness insurance was just formed in our country.However,with regard to the implementation process and effect of this policy,it was indeed necessary to carry out research systematically.In this thesis,a city J,which is site in the southwest of Shandong province,was selected as a subject for research.The related significative date and information were gathered from the government,the insurance company,medical institute and the participant through in-depth interview.Therefore,the implementation of this policy has teased out.During the implementation,based on the instruction from the superior government,this policy has been detailed by the government of this city and promoted its popularity via various forms.The financing for the critical illness insurance,which has been covered the urban and rural residents in this city,was rising year by year.Additional,there was no pay line for the registered impoverished households,and the more reimbursement ratio.This policy contributed significantly in poverty relief.The underwritten insurance company was auditing with the Social Security Bureau together.The insurance fraud in critical illness insurance was reduced effectively,as well as the risk of the insurance fund.Due to this policy,the "falling into or/and falling back to poverty from the critical illness" were avoided and the heavy economic burden was also released effectively.That is,the policy objective has been achieved partially.Moreover,the policy was increasing the operation efficiency,while the reducing administrative costs for the Social Security Bureau.Unfortunately,there were still many problems in the implementation process.The fundamental " break even & meager profit " of the policy has not been achieved.The insurance company was loss almost every year.The enthusiasm of underwritten insurance company for carrying out the critical illness insurance was reduced,which restricted the sustainability of this policy.In this case,insurance companies were only passively receiving services.The aggressive consociation was absence between the Social Security Bureau owing to the relationships between them was not equal.There were too many links between insurance fund collection and final reimbursement.Thus,the efficiency of the funds was reduced.In meeting with those problems,the corresponding improvement measures were proposed: including clarifying the role of the government in implementation,establishment of dynamic compensation mechanism scientifically,enhancing interaction between government departments and insurance institutions.