Analysis On The Implementation Effect Of The Serious Illness Medical Insurance System For Urban And Rural Residents In L City

The serious illness medical insurance system for urban and rural residents is a product of the reform of the medical and health system,and a beneficial supplement to the basic medical insurance system.It reimburses high medical expenses incurred by urban and rural residents due to major diseases through government supervision and commercial insurance companies,which can to some extent alleviate the pressure of urban and rural residents’ "poverty caused by illness and returning to poverty due to illness".Due to the close relationship between this system and people’s daily health,the whole society is highly concerned about it.In August 2012,the National Development and Reform Commission,in conjunction with six departments including the Ministry of Health and the Ministry of Finance,issued the "Guiding Opinions on Carrying out Serious Illness Medical Insurance for Urban and Rural Residents",which clearly proposed the pilot of serious illness medical insurance for urban and rural residents.L City actively responded to national policies and took the lead in implementing the serious illness medical insurance system for urban and rural residents in 2014.Although certain achievements have been made since the implementation of the system,there are also some problems.Studying the implementation effect of the serious illness medical insurance system for urban and rural residents in L city,identifying the existing problems,and proposing corresponding countermeasures and suggestions are of great significance for improving the level of social medical security in L city,constructing a multi-level medical security system,and building a service-oriented government.This article first uses the PEST analysis method to analyze the institutional background of major illness medical insurance,while defining the attributes of major illness medical insurance and clarifying the implementation goals.On this basis,the implementation status of major illness insurance for urban and rural residents in L city is analyzed from the perspectives of insurance participation,premium income and expenditure,and claim settlement.Subsequently,based on the 4E theory,the implementation effect of the serious illness medical insurance system for urban and rural residents in L city was evaluated from four aspects.The study found that its economy,efficiency,and fairness still need to be improved,and its effectiveness has been preliminarily realized.By comprehensively using literature research,questionnaire survey,and interview methods,a survey and analysis were conducted on the serious illness medical insurance system of urban and rural residents in L city.The following problems were found: low awareness of the system,unstable fund operation level,low reimbursement level,low participation of insurance companies,and unreasonable medical expenses leading to the loss of serious illness funds.To improve the serious illness medical insurance system for urban and rural residents in L city,the following suggestions are proposed: increase publicity efforts to enhance residents’ awareness;Improve the stability of the operation of the serious illness medical insurance fund;Improve the reimbursement mechanism for serious illness medical insurance;Stimulate the enthusiasm of commercial insurance companies to participate;Improve the supervision mechanism of major illness medical insurance.