The Study On The Integration Of Basic Medical Insurance System

This dissertation is an exploratory study on the integration of basic medical insurance system, which applies policy analysis and normative economics to the field of basic medical insurance system, through relevant theoretical research, social policy analysis and empirical research.With reviews to statistical data and analysis in reference literature, analyzing effectiveness and problems of current basic medical insurance system in the reform process, and referencing institutional framework and path of Medicare integration in the United Kingdom, the United States and Canada, we place the study in the social policy framework of social security integration, and make policy recommendations to construct the basic medical insurance system integration. Through related theoretical analysis and empirical research, the author has reached conclusions as follows:Firstly, China has established medical insurance systems, which mainly includes basic medical insurance for urban workers, urban residents basic medical and health care and new rural cooperative health care, and coversall urban and rural residents by the institution. But the three main systems have obvious "fragmentation" features. Three main systems belong to different departments, which are managed independently and closely. Funding capacity and Medicare ability of the three systems varies greatly. They have a poorer insurance equality and are inadequate from the true meaning of "universal coverage ".Secondly, In the field of social policy, starting from Bismarck and Beveridge model, concept and characteristics of "fragmentation" and "integration" were analyzed, possible theoretical foundation for integration of basic medical insurance system were combed, Carl Polanyi’s "embedded " theory is demonstrated as one of analysis framework of social policy for integration of basic medical insurance systems, the modern society’s paradoxical relationship between "market-society" is proposed:There are inherent contradictions between virtual goods and social movement of self-protection. Citizenship as a standard for individuals’social rights can de-commercialize labor force and be a theory trend of social policy, which is optional path to breakthrough the "market society" paradoxical relationship. and become a logical starting point for social policy research the theoretical basis for integration of health insurance is that social rights of citizens as qualifications for each citizen’s enjoy of health insurance fairly under any social conditions.Thirdly, the analysis of the basic medical insurance system from an economic perspective shows that health, particularly lying in personal health spending, will generate moral externalities. Consumers with a certain income, regardless of whether health spending is their first choice, will have a net loss on welfare. This is due to the existence of a private insurance company’s actuarial balance over the border, which cannot accept the loss of the border. Thus, a net loss of consumer welfare can only be compensated by the government’s resolution to make up the basic medical insurance system as quasi-public goods provided. From the normative economics level, the answer to the basic medical insurance system under certain constraints, and the best way to achieve its intended purpose, would be to achieve goals in the health insurance system resource scarcity premise and optimize resource configuration. The problem is that under certain constraints we can dictate the percentage of the national wealth for the basic medical insurance system by configuring it through specific channels; however, national wealth and personal wealth will still remain proportionate to the amount of burden caused by the manner in which the wealth is distributed.Fourthly, an analysis of the construct of international medical insurance systems including the United Kingdom, the United States, and Canada demonstrates that American health insurance utilizes a business model whereas the UK and Canada uses a universal health care model. Although large differences in values can be found between the design and associated content of each country’s health insurance system, the financing model of the public health insurance system in the United States and the funding model used by the United Kingdom and Canada are similar in that they both utilize general tax funding channels and sources. In this sense, and toward the characteristic of "integration", America’s public health insurance system provides health insurance through a general taxation system development-funding model in order to avoid the "fragmentation" of the path. Therefore, general tax financing is the best path to build an integrated basic medical insurance.Lastly, As demonstrated by the above analysis, the integration of the basic medical insurance system must be based on the following points:First, the integration of the basic medical insurance system should balance the relationship among service providers of third-party payers, consumers and medical insurance system by the successful price negotiation mechanism and a reasonable fee payment as a third party payer of health care market;Second, focusing on health risks, in addition to the medical market and consumers and service providers of third-party payers, all consumers should have equal access to health care; Third, the health care market should not be a market which fully arises from market failure in order to compensate those. Within the aspects of health insurance, because there is a big difference in response to the health risks associated with pension insurance and medical insurance, making institutional arrangements can not simply imitate and copy the pension system. The basic medical insurance funding mechanism should be open to independent pension insurance with the main consideration placed upon intra-generational redistribution of income and payroll tax in order to carry out the basic medical insurance integration build. Aspects of the treatment of the payment mechanism should use a hybrid-prepaid system, in addition to, establishing a unified health insurance agency responsible for the allocation of funds pay and price negotiations to health care institutions, in order to achieve the integration of the basic medical insurance system construction.