Study On The Effect Evaluation Of Commercial Insurance Company In Running Basic Medical Insurance In Anhui Province

Objectives : In this study,we investigated the implementation of basic medical insurance policies for urban and rural residents running by commercial insurance company in the pilot areas of Anhui Province,in order to know the overall progress,the implementation status and demands of each pilot area.At the same time,we evaluated the implementation effect of pilot areas from the aspects of operation cost,cost control effect and residents’ benefit,and look for the reasons affecting the pilot process.Then we analysed the achievements and problems of the pilot implementation in order to provide reference for improving the pilot policy,improve the pilot work,and provide ideas for promoting the reform of the basic medical security system.Methods:Through policy research and literature review,self-designed questionnaires were issued to collect the baseline data of commercial insurance companies in the pilot areas by self-filling method,and to understand the overall implementation situation.Data envelopment analysis was used to analyze the operational efficiency of10 pilot areas with complete data.Random sampling was used to analyze the operational efficiency of 10 pilot areas with complete data.Four sample areas(A,D,F,G)were selected to collect the operation data of basic medical insurance before and after the implementation of the pilot project in 2014-2017,and to analyze whether theoperation efficiency,operation cost,compensation balance of basic medical insurance fund and the satisfaction of the insured have improved compared with that of the government.Results :(1)Through the study of public service outsourcing theory and principal-agent theory,it is found that introducing commercial insurance companies into the management of basic medical insurance for urban and rural residents will help to realize the efficient allocation of medical insurance resources and improve the quality and efficiency of basic medical insurance supply services,but attention should be paid to the inconsistency of objectives,uncertainty and credibility between the government and commercial insurance companies.Interest barriers and other issues.(2)Operating efficiency: Using VRS model to calculate the overall efficiency of the basic medical insurance operation data of 10 pilot areas in 2016,we found that commercial insurance companies in four of the 10 pilot areas run basic medical insurance business in an effective state with an efficiency value of 1.(3)Operation cost of sample areas: The operation cost is expressed by government expenditure per insured population.Comparisons show that there is little change in the operation cost of basic medical insurance in four sample areas before and after the operation of commercial insurance companies.(4)Compensation and balance of basic medical insurance fund in sample areas: the actual compensation rate of basic medical insurance hospitalization in four sample areas has increased by 2-3.7 percentage points under the mode of commercial insurance companies;the benefit rate of basic medical insurance hospitalization compensation in four sample areas has increased by0.1-0.5 percentage points compared with that of the government;and the balance of medical insurance fund in the other three sample areas has increased by 0.1-0.5percentage points in the same year except for A.The rates remained around 10%.(5)Satisfaction and awareness of residents in sample areas: awareness of residents’ policies is 41%,and satisfaction of residents’ policies is 81%.Discussions and Suggestions: The evaluation found that commercial insurance companies have achieved some results after running the basic medical insurance business,alleviating the pressure of government undermanned to a certain extent,improving the level of basic medical insurance security,and the effect of basic medical insurance control fees is obvious.However,there are still some problems,such as imperfect system construction,especially lack of incentive mechanism,slow information construction,low professional level of full-time managers,overlapping functions and so on.Therefore,it is necessary to define clearly the functional division,give full play to the role of commercial insurance companies,rationally define the responsibilities of county medical community and commercial insurance companies;establish and improve relevant incentive and restraint mechanisms,establish incentive funds,formulate a scientific and reasonable incentive ratio,reward commercial insurance companies according to the audit situation;speed up the online work of intelligent audit system,and improve professional management.Level;Strengthen policy propaganda to improve the satisfaction of insured personnel.