Research On Family Mutual Aid Of Medical Insurance Personal Account ——Take Nanjing As An Example

On April 22,2021,the general office of the State Council issued the guiding opinions on establishing and improving the outpatient mutual aid guarantee mechanism of basic medical insurance for employees（hereinafter referred to as the opinions）,officially establishing the family mutual aid system of individual accounts of medical insurance for urban employees.The opinion points out that the personal account can be used to pay the medical expenses borne by the insured himself,his spouse,parents and children in the designated medical institutions,as well as the expenses borne by the insured himself when purchasing drugs,medical devices and medical consumables in the designated retail pharmacies.Explore personal accounts for individual contributions of spouses,parents and children to participate in basic medical insurance for urban and rural residentsAt present,several provinces and cities have introduced the implementation policy of individual account family solidarity,and equipped with various implementation channels.In March 2021,Nanjing issued the notice on adjusting the scope of use of employees’ medical insurance personal accounts,allowing urban employees’ personal accounts to achieve family solidarity and share family medical expenses.Individual account family solidarity has indeed played an important role in activating the precipitation of individual account funds and reducing the burden of family medical treatment.However,problems such as poor policy awareness,low participation rate of the masses,difficult mutual assistance in different places and frequent violations of medical insurance have gradually been exposed,and the masses’ sense of experience and satisfaction with the policy are insufficient.In view of the current situation of the operation of the family assistance policy of the individual account of basic medical insurance for urban employees in Nanjing,the author arranges the official data,issues questionnaires and collects typical cases,hoping to find problems,analyze the causes and find a breakthrough,and put forward suggestions for improving the family assistance of the individual account of medical insurance for employees in Nanjing and even the whole country.This paper is divided into six parts:The first part is the introduction,which mainly introduces the research background and significance of urban workers’ basic medical insurance personal account family assistance.Taking the exploration of family mutual aid of employee medical insurance personal account in Nanjing as an example,this paper uses a variety of research methods such as literature review,questionnaire survey and comparative research to provide direction for the sustainable development of policies.The second part defines the core concepts of the paper: basic medical insurance,personal account of basic medical insurance for urban employees,personal account of medical insurance for employees,and family solidarity,and introduces in detail the three basic theories used in the paper,namely,fairness and efficiency theory,Pareto Optimality Theory and incentive compatibility theory.The third part studies the current situation of employee medical insurance personal account and family solidarity in Nanjing.Firstly,it introduces the policy content,implementation basis and implementation of individual account family solidarity in Nanjing;Secondly,using Excel,SPSS and other statistical software to make a simple descriptive analysis of the questionnaire results,which is intuitively presented in the form of charts;Then select the influencing factors and use logistic regression analysis to find the significant factors affecting the participation results of individual account and family solidarity,so as to provide solid data support for subsequent suggestions.In the fourth part,based on the data in the third part,it is found that there are some prominent problems in Nanjing employees’ medical insurance personal account family mutual aid,such as low awareness of policies,insufficient number of participants,difficulty in mutual aid in different places,illegal medical insurance behavior and so on.The fifth part is the causes of the problems.The government propaganda work is not in place,the policy design itself is flawed,the local policies are not unified,and the supervision and management mechanism is not perfect,which will greatly reduce the expected effect of the policy.Take the reason as the breakthrough point and provide the basis for putting forward the solution.The sixth part is the countermeasures and suggestions.Strengthen publicity,innovate publicity methods and improve publicity efficiency;Combined with the local reality,improve the system design and improve the scope of mutual assistance;Strengthen local cooperation,improve the level of overall planning,and realize joint assistance in different places;Improve the supervision mechanism,innovate the management mode and increase the punishment.Finally,I hope that through the research of Nanjing,it can provide reference for other cities with the same problems,speed up the promotion process of China’s employee medical insurance personal account family solidarity policy,and make the dividend of personal account family solidarity policy benefit more people.