Study On Implementation Effect Of Typical Model Of Critical Illness Insurance For Urbanandruralresidents

Since the new medical reform,problems such as "difficult and expensive to see a doctor" have gradually aroused the attention of the society."Poverty due to illness","poverty due to illness" and other issues have become the focus of the whole society.In order to reduce the people’s medical burden and maintain social stability,The State Council issued the Notice on Deepening the Plan and Implementation Plan of the Reform of the Medical and Health System during the 12 th Five-Year Plan Period in 2012,which proposed to encourage the government to purchase services and entrust qualified commercial insurance institutions to handle all kinds of medical security management services,so as to establish a security mechanism for serious and serious diseases.In August2012,six ministries and commissions including the National Development and Reform Commission jointly issued the Guiding Opinions on the Work of Serious Illness Insurance for Urban and Rural Residents(No.2605,2012),formally determining that all localities should implement the serious illness medical insurance system for urban and rural residents nationwide in accordance with the original principle of "first testing and gradually pushing forward".Based on the in-depth study of Jiangyin model,Taicang model and Zhanjiang model,this paper draws lessons from RE-AIM model,makes a comprehensive evaluation from five dimensions: accessibility,effectiveness,adoption,implementation and sustainability,selects five first-level indicators and eleven second-level indicators,and sets up an evaluation index system for serious illness insurance.The weight of evaluation index is determined by AHP.After consistency test,Jiangyin model,Taicang model and Zhanjiang model are analyzed and evaluated from five aspects: accessibility,effectiveness,adoption,implementation and sustainability.The results show that Jiangyin model performs better in the actual settlement rate of medical expenses over 100,000 yuan and the balance rate of the overall fund,Taicang model performs better in the ratio of serious illness expenses to consumption expenditure and annual per capita financing,and Zhanjiang model scores the highest in the ratio of reimbursement of serious illness insurance.The final result shows that the implementation effect of the serious illness insurance model is ranked from high to low as Taicang City,Jiangyin City and Zhanjiang City.According to the research results,some suggestions are put forward,such as accurately positioning the insured object,implementing "secondary compensation",establishing long-term and stable financing methods,optimizing the cooperation mode with commercial insurance and improving the multi-faceted supervision system,so as to effectively improve the operation efficiency,service level and quality of serious illness insurance.