| Background : Driven by social and economic development,China has basically established a nationwide medical insurance system and achieved full coverage of the medical insurance system.Even so,the financial burden of a major illness on the sufferer and his or her family is so great that "illness into poverty,illness back into poverty" is a common occurrence.The prevention effect of basic medical insurance against "catastrophic health expenditure" is slightly insufficient.The level of national medical security is generally reflected by the level of serious illness insurance,so the serious illness insurance system is also an important means to maintain social order.From 2012 to 2015,the pilot work of serious illness insurance in China has been continuously promoted.Not only the government has paid attention to the issue of serious illness insurance,but also all sectors of society have focused their attention on it.During the 14 th Five-Year Plan period,it was proposed to improve the medical insurance for serious diseases,gradually build a multi-level social security system of sustainable development,and promote the realization of fairness and unity while paying attention to the overall development of urban and rural areas.Objective:Based on the theory of welfare pluralism,this paper analyzes the problems such as the loss of Insurance Fund for Serious Diseases in n city,the turnover of commercial insurance institutions,the difficulties in undertaking,the excessive medical treatment of medical institutions and the absence of public supervision,etc.,combined with the investigation of the satisfaction degree of the insured people in n city,the paper puts forward some countermeasures and suggestions to promote the development of the insurance.Methods : By using the method of literature research,this paper summarizes the general situation of the research on major disease insurance system of researchers in various countries,regions and fields At the same time,actively consult the website of Guangxi Bureau of Statistics and the official website of Guangxi and Guangxi municipal health committees to obtain policy documents such as "implementation plan of Major Disease Insurance";Interview method was used to understand the problems existing in the process of implementing the serious illness insurance policy in n city,and descriptive analysis method was used to analyze the social demographic information,chi-square test,independent t-test and IPA analysis were used to analyze the satisfaction of the insured.Results:1.The number of beneficiaries of serious illness insurance continues to increase,and N City continues to improve the medical insurance system and actively expand the coverage.From 2017 to 2019,the number of participants of serious disease insurance is 5,846,531,5,846,531 and 5,858,713,respectively,with the participation rate of 100%;The number of beneficiaries of serious disease insurance increased continuously,with an average annual growth rate of 40.67%.As of November 30,2020,a total of 7,117,700 people in N City have participated in the basic medical insurance,and a total of 5,912,700 people have participated in the serious disease medical insurance for urban and rural residents.2.The reimbursement rate of serious disease insurance has been gradually increased.The reimbursement rate of the first section of serious disease insurance in N City has been increased from 50% in 2017 to 60% in 2019,and the reimbursement rate of other sections has been increased by 5%;The reimbursement rate of the registered poor population is 10% higher than that of the general population,which has reduced the personal economic burden of patients,played a positive role in preventing poverty caused by illness and returning to poverty due to illness,and achieved good social benefits.3.The compensation for serious disease insurance increased rapidly,and the compensation for serious disease insurance from 2017 to 2019 was 220.4685 million yuan,412.03887 million yuan and 673.408 million yuan respectively.In2020,the compensation for serious disease insurance will be 70.2401 million yuan,with an average annual growth rate of 78.21% from 2017 to 2020.4.Profits and losses of serious illness insurance: The serious illness insurance for urban and rural residents in N City has suffered losses for three consecutive years,and the losses of serious illness insurance from 2017 to 2019 are 68.7089 million yuan,101.6081 million yuan and 277.0918 million yuan respectively.From January to September 2019,the expenditure of hospitalization pooling fund for urban and rural residents in N city increased by about 30% compared with the same period last year,and the expenditure of outpatient pooling fund for special chronic diseases increased by about 47%compared with the same period last year.The basic medical insurance fund for urban and rural residents appeared red alert from January to September 2019.5.The insured persons think that policy interpretation,rational drug use,reimbursement ratio,reimbursement time limit and payment limit are very important,but the actual implementation effect needs to be improved.Conclusions:Since it became a pilot city of serious illness insurance in2014,N City has made good achievements in policy design and insurance effect.Full coverage of serious disease insurance has been achieved,the number of people enjoying serious disease insurance benefits has been increasing year by year,and the level of insurance has been generally improved,which greatly reduces people’s medical economic burden.Policies such as lowering the minimum payment line and raising the reimbursement rate have helped the poor to basically solve the problem of basic medical security during the period of poverty alleviation.In short,serious illness insurance in N City has a certain positive impact on reducing people’s medical burden,and plays a certain role in promoting poverty alleviation.However,as the system has not been running for a long time and has not been mature,there are some problems as follows: the serious disease insurance for urban and rural residents has suffered losses for three consecutive years;Commercial insurance institutions can not give full play to their advantages and excessive medical treatment is difficult to curb;The financing standard of serious disease insurance is low and the financing channel is single;Serious disease insurance payment scope is not standardized;The two-way regulation mechanism of "capital preservation and small profit,risk sharing" is not perfect;Serious disease insurance propaganda and explanation is not in place;Information is not transparent,the absence of public supervision.Suggestions:Research suggests that N city urban and rural residents a serious illness insurance problem,you first need to set up the fund budget management regulation system,standardization of a serious illness to pay limits and raise fu biao,improve the comprehensive control cost measures,give full play to their professional advantages,at the same time inspire insurance institutions to strengthen the regulation of commercial insurance,promote diversified and information supervision mechanism;Secondly,combining the theory of welfare pluralism,optimization of multiple subject interdependence of the urban residents’ social support system,serious illness insurance over a serious illness insurance financing channels for a single problem,establish a diversified,social financing channel,enhance nongovernmental organizations(ngos)to the support of a serious illness insurance,urban and rural residents to promote N,quality,and the growth development of urban and rural residents a serious illness insurance. |
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