Study On Optimizing Link-up Model And Strategies Of Medical Assistance And Basic Medical Insurance

Study PurposeThis Study aims to, through screening the theories related to the link-up between medical assistance and basic medical insurance as well as empirical analysis of the current link-up between medical assistance and basic medical insurance system for urban and rural residents, explore feasible optimized link-up model and strategy for the two systems in such aspects as policy objectives, scheme design, service management and departmental collaboration mechanism, in order for realizing a "seamless link-up" between medical assistance system and basic medical insurance system.Study Methodology The data sources for this Study include literature materials,2007-2010 Chinese Health Statistics Yearbooks and macro-data collections from the statistical data of the Ministry of Civil Affairs of PRC as well as the filed surveys in typical regions. Study methodology includes literature analysis approach, typical case approach, special-topic group interview and quantitative analysis.Study Results1. This Study theoretically analyzed the natures and characteristics of basic medical insurance system and medical assistance system. The characteristics of basic medical insurance include universality, equality, reciprocity, financing adequacy and security limitation. The characteristics of medical assistance system include specifically of populations, singleness of fund channel, limitation of assistance level and cooperatives with basic medical insurance. The similarities of the two are embodied in: (1) Both aim at achieving the common policy goal of ensuring basic health care services for every one; (2) The government plays a dominating role in the process of system establishment and development; (3) Both have common designated medical service institutions; (4) The medical service contents are similar, and both focus on major diseases, aiming at solving the basic security issues of hospitalization, and giving consideration to outpatient services; (5) Both have the same catalogues of diagnosis and treatment and medicine use; (6) Both have the same method for expense compensation and subsidy. The differences between the two are manifested in different natures, different populations covered and security scopes, different security procedures, different fund-raising channels, different management systems. So there is relative independence between the two, and a parallel relation is constituted in structure; there is also a dynamic relation between the two in compensation time and mutual influence. The necessities, feasibility and barriers for the link-up between medical assistance system and basic medical insurance system. Necessities includes: (1) Effective link-up between the two systems is a necessary condition for ensuring poverty populations benefiting therefore. (2) The combination of the two systems facilitates hospitals is good for the supervision of medical institutions. (3) The link-up at management level facilitates reducing management costs of systems. (4) The link-up for reimbursement service facilitates realizing instant assistance. (5) To eliminate the bad effects of system operating independently. The feasibility for the link-up between the two includes policy security and complementation. Complementation include complementation between governmental responsibilities and personal responsibilities, complementation in security objects between all populations and poverty populations, complementation in security procedure between standard ability and flexibility, complementation in security content between unity and particularity, and complementation in security level between universal benefit and emphasis. The barriers for the link-up between medical assistance system and basic medical insurance system include three aspects, namely:the division of departmental duties causes the separation between systems, while the separation between systems influences the utilization of health care services by poverty populations, whereas low-level basic medical insurance for urban and rural residents brings about high pressure to the link-up of medical assistance.2. By use of macro-data, this Study describes the status quo and development trend of the link-up between medical assistance system and basic medical insurance system at nationwide level from three aspects, namely populations covered, raising and use of funds and system link-up, and finds the existing main problems as follows:(1) Financial aid-based insurance participation rate and participation rate of New Cooperative Medical System have been improved significantly in recent years, however, the requirement for "covering all required" still has not been met; (2) The level of compensation for urban and rural assistance objects is relatively low, which results in a greater gap from the needs of poverty populations; (3) Basic medical security system preliminarily established a fund-raising mechanism for steady growth, but the fund-raising level is still on the low side; (4) The development of inpatient assistance and outpatient assistance is unbalanced, so work should be done to further scientifically design the assistance contents and the composition of funds expenditures.3. The link-up modes of "one-stop" instant settlement are classified, from the perspective of information system, into three types:unified development type, independent development type and guiding record type. These three modes have their own characteristics in link-up manner, management efficiency and information sharing, and all of them improved the inpatient assistance rate and reduced the fund balance rate after the implementation thereof, therefore, they help increase the access to medical assistance, meanwhile reduce management costs and improve work efficiency of medical assistance. The reform conditions are those:(1) New link-up modes poses higher demands to the coordination capacity of the department of civil affairs; (2) The link-up modes of "one-stop" instant settlement need the establishment of a steady mechanism for fund raising; (3) The department of civil affairs need to strengthen regulation of designated medical institutions; (4)The information system need the constant improvement in personnel certification.The existing main challenges include:(1) Significant increase in the hospitalization rate of assistance objects brings about risks to the safety of assistance funds; (2) Instant settlement is limited by regions and designated medical institutions, hence influencing the access to and equity of medical assistance; (3) The unification of the systems of basic medical insurance for urban and rural residents has not yet been realized, which influences the integration of medical assistance instant settlement at provincial level.4. This Study takes into account the characteristics of system link-up and the modes of "one-stop" instant settlement, selected four typical regions from East, Central and West China, namely Shaowu City of Fujian Province, Jilin City of Jilin Province, Hechuan District of Chongqing City and Huzhu County of Qinghai Province, analyzed the effects generated after link-up of medical assistance with basic medical insurance for urban and rural residents, and compared the characteristics of different link-up schemes and modes. The effects after link-up are manifested mainly in increase in hospitalization assistance rate, decrease in fund balance rate, improvement in the security level of assistance objects and shortening of the time of waiting for examination for approval.5. On the basis of system analysis method, this Study put forward the optimized model for link-up between medical assistance system and basic medical insurance system for urban and rural residents. The model consists of logic frame and structure frame. The logic frame is built by the logic chain of "system target-system environmental-system elements". And the structure frame includes four aspects, namely policy link-up, organizational management, technical design and service management. Wherein, organizational management includes two aspects, namely departmental duties and coordination mechanism; technical design includes four link-up levels and five key technical links; service management includes five parts, i.e. personnel management, fund management, supervision and control, information service and settlement service. The link-up strategy includes five aspects, namely doing well the work for poverty populations'participation in insurance and New Cooperative Medical System, and enabling assistance objects to enjoy basic medical insurance of general populations; a fund raising mechanism for medical assistance should be established with growth in step with Chinese economy level; on the basis of reasonable estimation of needs for medical assistance funds, scientifically adjusting medical assistance policy; improving medical assistance system, and providing system security for advancing "one-stop" instant settlement.The Innovations of This PaperThe innovations of this paper are those it merged the theoretical analysis, realistic obstacles and mode selection of the link-up between medical assistance and basic medical insurance according to the logic chain of "system target-system environmental-system elements" of system analysis method, and realized the procedure from theory to practice and then from practice to theory, proposed the link-up optimized model of the two systems by combination of theory and practice.The Flaws of This PaperThe flaws of this paper are those it lacks the data of economic burden of sickness and degree of satisfaction. And the paper could further study on the effect of system link-up by available data and enough time.