| As of December 2018,there are 134.45 million people participating in basic medical insurance in China,with the proportion of insured persons exceeding 95%.The people have basic medical treatment guarantees.However,according to the Decision on Establishing the Basic Medical Insurance System for Urban Employees issued by the State Council(No.44 of Guofa [1998]),the original intention of the design of the basic medical insurance was that the level of basic medical insurance should be in line with the level of productivity development in the primary stage of socialism.The intention leads to the objective reality of wide coverage and low level of basic medical insurance in China,which makes residents still bear a heavy burden when facing serious disease,for example the phenomenon of returning to poverty due to illness still exists.At the same time,according to the document,"all employing units and their employees in cities should take part in basic medical insurance and the managing method of medical insurance should be territorial management",which leads to a considerable balance of basic medical insurance funds in some areas and serious shortages of basic medical insurance funds in other areas.In this situation,in 2012,Guiding Opinions on the Development of Serious Disease Insurance for Urban and Rural Residents was issued,which reformed and innovated the management and operation mechanism of public services.In order to further reimburse the medical expenses of patients with serious diseases,commercial insurance institutions were involved in a market-oriented way to provide service.China started to develop the urban and rural residents’ serious disease insurance system relatively late.There is still much room for improvement in financing,management and security level.Based on the author’s long-term working experience in commercial insurance companies,this paper chooses urban and rural residents’ serious disease insurance as the research object,and takes the implementation of urban and rural residents’ serious disease insurance in Chengdu as the research theme.Through the analysis of its current situation,features and process,this paper discusses and summarizes some important problems in the implementation of urban and rural residents’ serious disease insurance.Combined with China’s national conditions,the author puts forward countermeasures and suggestions to solve the problems,in order to provide a positive and useful reference for the implementation of urban and rural residents’ serious disease insurance.Through the analysis of the background and meaning of urban and rural residents’ serious disease insurance,the study past literature,and the comparison of different research methods,the first part of the article identifies the research object,perspective,focus and structure of the paper.The second part defines urban and rural residents’ serious disease insurance from the theoretical level by defining the concept,nature and theoretical origin of urban and rural residents’ serious disease insurance.The third part is the case study,through the analysis of implementation status in Chengdu of urban and rural residents’ serious disease insurance,summarizing the outstanding problems.The fourth part points out and summarizes the causes of these problems,including five reasons: unreasonable reimbursement,low level of financing,many uncertain factors,the government’s intervention,and insufficient effect evaluation.The fifth part is to analyze and draw lessons from the implementation experience of serious disease insurance for urban and rural residents in developed areas.The sixth part,based on the reality of domestic administrative system,puts forward specific suggestions to improve current situation,including broadening the data channels,enhancing the applicability and rationality,expanding the financing channels,establishing a dynamic adjustment mechanism,improving the effectiveness of the cooperation and supervision mechanism between government and business,clarifying the functions of the government,correcting the role orientation,and actively promoting the intelligence of medical supervision. |
