Study On The Evaluation And Countermeasure Of The Implementing Effect Of Basic Medical Insurance For Urban And Rural Residents In Jiangsu Province

Objective: With analyzing the construction,implementation and impact of the basic medical insurance system for urban and rural residents in Jiangsu Province,we evaluate the effect of the insurance during the integration of the basic medical insurance system for urban and rural residents in Jiangsu Province.It finds out the problems of insurance participation,financing,reimbursement and fund operation before and after the integration.Based on the study,we can provide policy suggestions for the implementation of basic medical insurance system for urban and rural residents in Jiangsu Province.Materials and Methods: By understanding the documents of basic medical insurance for urban and rural residents in Jiangsu Province,summarizing the relevant documents related to the evaluation of medical insurance,and expert consultation,a scientific index system is formed.Using the theoretical framework of Structure-Process-Outcome(SPO),descriptive analysis,regression analysis and data envelopment analysis,we can evaluate the integration of basic medical insurance system for urban and rural residents in Jiangsu Province.Result: From 2015 to 2017,basic medical insurance for urban and rural residents has achieved a comprehensive integration of the agencies,the basic preparations for system integration have also been completed.And the overall planning level has gradually risen from district to city level.The participation rates of Urban and Rural Residents Medical Insurance(URRMI),Urban Residents Medical Insurance(URMI)and the New Rural Cooperative Medical Insurance(NRCMI)were above 95% from 2015 to 2017,basically achieving population coverage.The results show that from 2015 to 2017,the proportion of individual financing of basic medical insurance for urban and rural residents has dropped to about 20% and the government subsidies were more than 450 yuan per person.The proportion of individual financing to per capita disposable income was reasonable.During the transitional period,the fund was running smoothly.But the operation efficiency was necessary to be improved.The fund balance rate of some cities was less than 10% in 2017.From 2015 to 2017,the reimbursement ratio of hospitalization expenses of the basic medical insurance for urban and rural residents was 77.71%,78.42%,81.90%,and the actual reimbursement ratio was 53.03%,56.19% and 51.63%.Compared with UURMI and URMI,the actual reimbursement ratio of the NRCMI was lower,and the difference between urban and rural areas was obvious.In 2015,the overall planning of outpatient clinics has been basically realized.But the actual reimbursement ratio of outpatient clinics was decreased,which was 38.68%,38.37% and 36.04% from 2015 to 2017,respectively.The integration of basic medical insurance for urban and rural residents has led to certain fluctuations in the political and actual reimbursement ratio.The reimbursement of basic medical insurance for urban and rural residents lacked fairness in urban and rural areas and in different income levels.Suggestions: The medical insurance of urban and rural residents in Jiangsu Province is still in the initial stage of integration.In order to ensure that the medical needs of residents are fully met and the medical insurance system covering the whole people can be established and improved,five suggestions are put forward for the basic medical insurance for urban and rural residents in Jiangsu Province.First,we should integrate urban and rural medical insurance in an orderly way to improve the overall level;second,we should set up diversified financing standards and establish a stable financing mechanism for basic medical insurance for urban and rural residents;third,we should unify the reimbursement policy and provide fair basic medical insurance for urban and rural residents;fourth,we should establish a unified fund management account and adhere to the principle of "balancing revenue and expenditure with fixed expenditure".Fifth,we can rationally allocate medical and medical insurance fund resources to improve the efficiency of basic medical insurance for urban and rural residents.