A Study On The Anomie Behavior In The Cracks Of Urban And Rural Residents’ Medical Insurance System

Since the State Council’s opinion on the integration of basic medical insurance system for urban and rural residents was issued in 2016,China’s medical insurance pattern has changed from the original three parts of urban and rural residents’ medical insurance,new rural cooperative medical insurance and employee medical insurance to two parts of urban and rural residents’ basic medical insurance and employee medical insurance.Urban and rural medical insurance and new rural cooperative medical insurance are merged into urban and rural residents’ medical insurance.This means that the unbalanced distribution of medical resources caused by the original urban-rural dual structure is gradually broken.This paper focuses on the basic medical insurance of urban and rural residents after the merger.After the combination of urban and rural residents’ medical insurance,the overall planning system is implemented.The benefits of this system are to improve the utilization rate of funds,effectively promote the balance of medical resources between urban and rural areas.The urban and rural residents’ medical insurance system not only helps urban and rural medical insurance,but also has a good development.The combination of urban and rural residents’ medical insurance is not long,because of historical reasons,there are still large institutional cracks,and the degree of system integration needs to be improved.Based on this,the system combination of urban and rural residents’ medical insurance also brings many disputes.punished by the system even if they make mistakes.Improving the system plays an important role in promoting the growth of urban and rural residents’ medical insurance system.The institutional gap provides the soil for the anomie behavior of the designated medical institutions.Firstly,the current system is not detailed enough for each subject’s supervision system.Although the symbolic provisions stipulate that the designated medical institutions must establish an internal supervision mechanism,the designated medical institutions make the internal supervision virtually exist in the actual operation,and the lack of actual implementation of the system makes the supervision become an empty talk.The imperfection of the voucher audit system also brings space for the anomie behavior of the designated medical institutions.In real cases,there are often false information related to the original voucher.The reason is that the designated medical institutions are very familiar with the audit system,and the experienced institutions do not tamper with the information on the printed original voucher,but directly enter the information in the electronic system of the original voucher At the same time,illegal operations are carried out and false information is input.According to man’s theory of rational choice,action system includes action,resources and interests.Actors control the resources that can make other people obtain interests,and meet their own interests needs through resource exchange and behavior interaction with others.Through the analysis of the operation process of urban and rural residents’ medical insurance,there are three stakeholders involved in urban and rural medical insurance,one is the insured,the other is the designated medical institutions(including: designated hospitals and designated pharmacies),and the third is the urban and rural residents’ medical insurance agencies.They control different resources,not only wealth,but also goods,information,skills and so on.For example,doctors know more about the medical insurance system than ordinary insured personnel,and the business operators in medical insurance institutions know more about medical insurance than doctors.In the action system,the resources controlled by the actors are limited.These resources may not be the needs of the holders themselves,but the actors can exchange these resources with others to obtain the resources they need more,so as to realize the behavior interaction between people.In the medical insurance of urban and rural residents,where there are often Anomies,resource exchange will be involved.In order to obtain higher benefits,or to use a pack of cigarettes,or to use institutional loopholes,or to use other resources,in a word,it is for small sacrifice and large gain.From the perspective of micro rational person,anomie behavior is caused by the interest groups of all parties of medical insurance.From the macro social level,it is due to structural obstacles or even gaps in the system.These anomie behavior caused the author’s thinking,how to operatethese phenomena? Why do these phenomena happen? What are the consequences of these irregularities? How to create a more reasonable system environment? Through the interpretation of the urban and rural residents’ medical insurance system,the combing of the urban and rural residents’ medical insurance system,the analysis of the group’s anomie behavior involved in the medical insurance system,based on the cases,the author tries to present the formation logic of the anomie behavior and its impact,and at the same time,tries to put forward suggestions for the improvement of a fairer reimbursement system.