A Study On The Level Of Suitability Of Financial Standard And Reimbursement For The Basical Rural-urban Residents Medical Insurance

The integration of urban and rural residents’ basic medical insurance is the specific goal of establishing and improving the basic medical security system of the urban and rural residents in the new medical reform scheme,and realiz the basic medical security for all.The level of medical insurance guarantee is the concentrated expression of the effect on the medical insurance system,and the stable level of financing and the compensation level adapted to it directly reflect the solvency of medical insurance on health risk.On the one hand,urban residents’ medical insurance and NCMS are basically similar to the financing level,security level and operation supervision.But it has not yet formed a stable adjustment mechanism for financing standards,and the financing structure has not been reasonable and fair.On the other hand,the solvency of medical insurance directly reflects the security of medical insurance system.While the reform of the payment mode in the integration process is too single and the actual compensation of the fund is insufficient,the medical needs of the insured personnel can not be met.The reimbursement mechanism for the chronic diseases and major diseases has not yet been perfected,and the compensation responsibility for the public hospitals is not yet in place.Therefor,new policies should be put forward in order to pefect the basic medical insurance system in urban and rural areas.The main purpose of this study is to analyze the basic medical insurance policy practice of urban and rural residents in J city of Hubei Province.Based on the data of urban and rural residents’ basic medical insurance received from J city in 2017 as the sample for study,this study is intended to analyse how to raise funds for the basic medical insurance of urban and rural residents based on the different compensation schemes so as to judge whether the design of the payment scheme is reasonable in the operation of the new system or not,and how to maximize the benefit level of the insurance to decreasing the medical cost.This study shows thatthe data sampled from J city of Hubei Province in 2017 as the basic sample,calculates the quantity need of financing needsbased on the basic medical insurance of urban and rural residents in the year,considering the different economic capacity of the residents,simulating the level of four kinds of financing compensation schemes,and discussed the 4 different resigned schemes with a range of very compensation levels.The compensation for outpatients is 30%,40%,50%,60%,respectively,and the compensation for hospitalization is 50%,60%,70%,80% respectively.The amount of government funds allocated by the four party scheme is 1.696 billion,3.085 billion,6.274 billion and 8.278 billion,respectively,and the amount of financing required by residents is not more than 500 yuan.According to the ideal compensation level of the policy,the individual financing should be 30%,and the government financing should be up to 70%.It is obvious that the current financing level of the J city is increasing gradually and the proportion of the residents’ fund-raising is rising gradually too.However,there is still a potential risk exposed tothe medical fund,and the cost control is still of great significance.Therefore,it is an important way to measure the level of real security and integration in the process of basic medical insurance for urban and ruralresidents.