Study On The Feasibility Of Provincial Level Pooling For The Management Of Medical Insurance Fund In Xinjiang Production & Construction Corps.

The medical insurance system in China has been conducting a continuous reformation for years. However, series of issues are hindering the implement and management for medical insurance agencies national wide. There are differences and unfairness on medical treatment levels among medical institutions in varies areas due to economical and social development status. The mutual aid function of medical insurance is inadequate and capability to withstand risks is not optimistic, either. Furthermore, the inefficiency in medical insurance transferring and medical treatment reimbursement among provinces are also huge challenge to the system. Whereas, a higher level pooling of medical insurance fund will provide a proper solution for the abovementioned issues, especially in Xinjiang Production & Construction Corps.(XPCC for abbreviation), whose special organizational structure is more convenient to adopt to this new pooling system. Furthermore Article 68 of Law of Social Insurance in PRC indicates that the basic pension insurance fund can gradually realize a national pooling management system, and the other kinds of insurances will implement provincial level pooling of fund management step by step according to the schedule and procedures made by the State Council. This is the first time to clearly regulate the level of pooling management by law, which means that medical insurance fund can have higher level pooling.This research is based on the background of building system with a maximum coverage of population to insure basic medical insurance gradually national-wide. Through inductive and deductive reasoning, the status of basic medical insurance fund management in division level in XPCC is analyzed to reveal the issues, difficulties, and causes of this system as well. Then, the history of the basic medical insurance system and opportunities it faced is discussed thus to make a comparison on the fund raising and medical reimbursement level among the fifteen divisions of XPCC in order to find their similarities. After elaborating on the urgency, significance and feasibility of provincial level pooling on the management of basic medical fund in XPCC, a conclusion will be reached that it is possible to pioneering into a provincial level pooling for the medical insurance system in XPCC due to its special organizational structure.According to the above mentioned studies, five conclusions can be researched:(1)Has raised the issue in the Division level of pooling for medical insurance fund in XPCCThere are differences in medical insurance reimbursement among divisions thus caused conflicts since the insurance appliers compare would compare that with each other. The mutual aid function of medical insurance is inadequate in the divisions and capability to withstand risks is not optimistic, either. The efficiency of fund usage cannot be improved and the quality of medical services is hard to guarantee. Difficulties in the transferring of medical insurance among provinces or districts have hindered the free flow for employment in different locations freely. For those issues, people will apply for medical insurance in several institutions. And it cost more to operate and manage the insurance system.(2)Analyzed the roots and causesThere are historical, social and economical causes for the issues exposed in the medical insurance system in XPCC as well as its systematical status. First, issues have been existed in the development of the XPCC since its foundation. Second, it is uneven in economic development among divisions in XPCC. Third, there are huge differences about the number of insured population among divisions. Fourth, it is inevitable for the usage of the insurance fund to have lower efficiency in division level pooling. Fifth, capabilities of distribution on public resources are inadequate due to low level pooling of fund. Sixth, the number of population insuring in difference divisions is huge and reaching for medical treatment beyond the insured locations is hard for the same reason mentioned above.(3)Presented the feasibility for the XPCC to implement a provincial level pooling of medical insurance fundNecessity and background have been analyzed in this part. For the necessity, there are four aspects. Firstly it will meet the national goal of reformation in medical system in China. Secondly, it will satisfy the needs to secure the rights of insured group and adapt to the socialist market system. Thirdly, it reflects the objective needs for the management of medical insurance system. And lastly, it is a symbol for the mutuality of the medical insurance system.Four main conditions have been ready for the provincial level pooling in XPCC. They are the specialty of the system in XPCC, comparatively smaller difference among divisions in fund raising and reimbursement among divisions, increasing wills for insured group, and the financial aid provided by the central government.(4)By analyzing the experience of domestic and foreign medical insurance practices, problems that might encounter can be predicated for the implement of provincial level pooling of medical insurance fund in XPCC.(5)Solutions and SuggestionsPossible solutions and suggestions are proposed to realize the provincial level pooling of medical insurance fund in XPCC based on the issues and analysis correspondingly. Hopefully, they can provide references for elevating the pooling level of medical insurance fund thus to make further development of the medical insurance system in XPCC.