An Investigation Report On Xinyu City's Commercial Health Insurance's Participation In The Construction Of Multi-level Medical Security System

For many years,the Xinyu Municipal Government has always put people's health in a strategic position as a priority for development,established a sound medical security and medical assistance system,and established close cooperation with PICC Health's Xinyu Branch through the government's purchase of services.PICC Health As the only state-owned professional health insurance company in Xinyu City,the company leverages its commercial health insurance company's superior resources to give full play to the advantages of professional health insurance,and strengthen commercial health insurance to participate in the construction of a multi-level medical security system;In addition,in terms of basic medical insurance,critical illness insurance,supplementary insurance for the poor population on file,civil assistance insurance,and financial support,the integration of the "five medical guarantee lines" has achieved integrated management,one-stop settlement,and the whole process.Medical risk control,comprehensive medical security,and full life cycle health management services have achieved remarkable results,improved the overall health of citizens,and innovated a new model for the insurance industry to participate in the construction of a multi-level medical security system.Although PICC Health has achieved certain results after participating in the construction of a multi-level medical security system in Xinyu City,such as in the management and control of medical expenses,from 2012 to 2019,it has managed and communicated a total of 1476,000 cases of problems in hospitals in Xinyu City.Directly reduce the unreasonable medical insurance fund expenditure by 183.38 million yuan,and indirectly reduce the unreasonable medical insurance fund expenditure by more than 234.9 million yuan.But at the same time,there are still some problems to be solved in the process of Xinyu City's commercial health insurance participating in the construction of the medical security system.From the perspective of the management and innovation of the Xinyu branch of PICC Health,this article comprehensively uses the research methods of comparative analysis,economic analysis,historical analysis and normative analysis to summarize the basic practices and development status of PICC Health's participation in the construction of the Xinyu medical security system,Summarize the problems of Xinyu City's commercial health insurance participating in the construction of a multi-levelmedical security system,and give several countermeasures.The following parts are included in this essay : First of all,this essay,this article briefly describes the concept of commercial health insurance and its functional positioning,the concept of multi-level medical security system and commercial health insurance participating in the construction of medical security system,and from filling the gaps in social medical insurance,From the three perspectives of improving the comprehensive protection capabilities of medical insurance and promoting the effective combination of medical insurance and commercial insurance,the importance of commercial health insurance participating in the construction of a multi-level medical insurance system is explained.In the second part,this research report analyzes the current status of Xinyu City's commercial health insurance participation in the construction of the medical security system based on field research.It mainly starts from two aspects: basic practices and development status,combined with the level of Xinyu City's medical security in recent years.,The level of medical expense reimbursement,the people who really benefit,and the income of commercial health insurance premiums,etc.,conduct an in-depth analysis of the development status of Xinyu City's commercial health insurance participating in the construction of the medical security system.The third part is the existing problems.After analyzing the current development situation,the author believes that in the development process of Xinyu City's commercial health insurance participating in the construction of the medical security system,there are mainly the following problems:Commercial health insurance is in the medical system Limited role,increased operating risks of insurance companies,higher moral hazard of insured persons,and inefficient operation of medical institutions.The fourth part is international experience and enlightenment.Through summarizing the experience of commercial health insurance in the United States,the United Kingdom and Germany in participating in the construction of the medical security system,we have obtained enlightenments such as clarifying government and market positioning,a complete set of policies and rules should be built,and tapping the development potential of commercial health insurance.The fifth part is the core content of the article.This article adopts the method of dealing with specific problems in detail,combining the problems summarized in the previous article,andproposes that the following four aspects need to be addressed.problem.The first is to enhance the insurance and risk prevention awareness of insured persons;the second is that insurance companies should strengthen their own business management;the third is to build a long-term mechanism for the education of insured persons;the fourth is to strictly regulate and supervise the main body of medical services.It is hoped that the analysis and countermeasures in this article can play a certain role for Xinyu City's commercial health insurance to better participate in the construction of a multi-level medical security system,and can give full play to the health risk protection role of commercial health insurance,and promote the health of the people in Xinyu City.It is helpful to improve and harmonious development of society.