Researches On The Evaluation Theories And Application Of Urban-Rural Resident Basic Medical Insurance System

Urban and rural resident basic medical insurance system has the significance for improving medical security of urban and rural residents. Since 2009, a series of policy documents were produced by government to push ahead with the reform of the urban and rural resident basic medical insurance system, and system construction began to been set into motion in some province gradually. More than 20 areas had the basic medical insurance system for urban integrated with the New-type Rural Cooperative Medical Insurance System by 2014, and urban and rural resident basic medical insurance system have taken another step forwards. But at the same time, the a lot of problems already exist in the process of the Urban and rural resident basic medical insurance system construction, such as the government face a heacy financial burden, insured people only enjoy a low medical security, insurance fund is short and so on. Therefore, urban and rural resident basic medical insurance system has pace with the economy and income of both urban and rural resident are the key to the development of medical insurance system.On the basis of rationalizing and summarizing relevant research results for oversea and domestic, this desertatiion makes comprehensive evaluation for effects of medical insurance system for urban and rural residents in our country. In addition, questionnaire survey is carried out with Tianjin as the emphasis to resolve the problems existing in operation process of medical insurance system for urban and rural residents of Tianjin. It expounds the study conclusion of this desertatiion, policy enlightenment, and insufficiency in study and expectation in the end. Main study results of the paper are as follows:(1) Horizontal comparison of medical insurance system for urban and rural residents shows significant difference exists among medical insurance system for urban and rural residents in all provinces and cities due to effects of economic development level and other factors. The security level and equality in participation of medical insurance policy of our country are resolved basically at the same time. However, medical service security level and sustainability of medical insurance is to be improved. Vertical comparison result shows: the coverage rate of medical insurance system for urban and rural residents is increased year by year and policy guidance is improved year by year; Awareness, satisfaction and support of residents to medical insurance system for urban and rural residents are improved year by year. Compared with medical insurance system for urban employees, the proportion of individual payment and surplus of medical insurance fund of medical insurance system for urban and rural residents is relatively low.(2) The study result for real security level of medical insurance for urban and rural residents based on microcosmic individual data shows that there is a great gap between the real medical security level of medical insurance of insured persons with different participation types, payment levels and ages and the policy security level. At the same time, level of hospitals providing medical treatment for insured persons and medical expense level produce significant effects on the real security level of urban and rural residents.(3) The study for proper surplus level of medical insurance fund for unban and rural residents based on system dynamics shows that the proper surplus level of medical insurance fund for unban and rural residents of Tianjin is 23%. This level is close to index value of 20% thought by scholars. In order to achieve the proper level, individual payment ratio should be further improved during the process of raising fund for medical insurance. The average security level of medical insurance should be improved appropriately at the same time.(4) The study for efficiency of medical insurance system for urban and rural residents based on the angle of policy tools show that there are relatively more environmental-type policy tools in the policies of medical insurance for urban and rural residents in our country at present. The supply-type policy tools are second to it and the demanding-type policy tools are fewest. Utilization degree of supply-type and demanding-type policy tools should be improved from multiple angles such as medical service institutions, patients and market during the development process of medical insurance system for urban and rural resident in the later period.According to the results, this article put forward reasonable suggestions from the view of improving the mechanism of financing and compensation, creating security level assessment mechanism, and the fund warning mechanism,.etc.