The Research On The Social Medical Insurance Model Of Zhuhai City And Its Impact On Medical Expenses

ObjectivesThe aim of the study was to summarize the characteristics of ZhuHai City health insurance system model, to analyze the operation status of ZhuHai City health insurance fund, to study the influence of ZhuHai City health insurance policy on the medical expenditure and to find out the problems and causes of them, on the base of the requirement and framework of prevalent Chinese health insurance reform and in reference to the practices of health insurance implementation in other advanced provinces. Countermeasures were put forward to provide reference for the government policy-making in order to improve the basic health insurance system of ZhuHai City.Contents1. The discussion of the Social Health Insurance theory.2.The development and evaluation of ZhuHai City health insurance policy3. The characteristics summarization of ZhuHai City health insurance model4. The systematic dynamics study of ZhuHai City Worker Basic Health Insurance5. The impact of the ZhuHai City health insurance policy on the medical expenditureMethods1. literature review2. System dynamics3. Quantitative analysis system of ZhuHai City.Results1.The rate of Zhuhai City Social Health Insurance from 2003 to 2007 respectively were 48.6%, 54.2%, 60.5%, 68.8%, 76.2%, and the increasing speed of the insured population surpassed that of the population in census register. The insured population ranked second in the five social security insurances in the passing years, and the increasing rate of the insured was higher that those of the other social security insurance.2.From 2003 to 2007, the compensated people was increasing yearly for the various city health insurances in Zhuhai City, and it reached the highest in 2008, that is 52187 people; the surplus of Social Health Insurance Fund respectively were: 6341, 4715, 5883, 7454, 17776 ten thousand yuan; it was very steady for the changes of average yearly increasing rates of the income, the expenditure and the surplus of the Fund.3.The premium rate of the City Worker Basic Medical Insurance (CWBMI) for the employer was 7%, which was lower than those of Suzhou City, Chengdu City, and Shamen City; the lowest line of the premium for the employee was 80% of the basic salary of the insured worker, which was 60% higher than those of the other cities. The income of the individual account of Zhuhai City CWBMI was 3% to 4% of the salary of the insured worker, which was lower than that of Shamen City. The foreign population could only join the serious disease insurance instead of the basic health insurance, and the coverage of the juveniles and city citizens was insufficient in Zhuhai. Comparing the fiscal income of Zhuhai to those of the other three cities, the fiscal subsidies and the enjoyed benefit package of the medical insurance of foreign population, the juveniles and city citizen were lower than those of the other three cities.4.The systematic dynamics analysis showed that the population in census register would reach 102.127 ten thousand people in 2017 in Zhuhai City and the gross national product would reach 3597 billion yuan, and the CWBMI Fund would reach 502356 ten thousand yuan. The total Fund would be affected by the gross national product.5.The components of inpatient expenditure of the insured and non-insured showed that the expenditures on drug, care and bed ranked the first three factors which affected the average expenditure of insured inpatient while the expenditures on bed, drug and care ranked the first three factors which affected the average expenditure of non-insured inpatient.6.The covariance analysis showed that the part of the daily inpatient expenditures of the insured was lower than that of the non-insured inpatient, but the average length of the stay of the insured patients was longer that that of the non-insured patients.Conclusions1. The coverage of ZhuHai City Social Health Insurance reached 76.2% of the whole population due to the early start of The City Worker Basic Health Insurance, the establishment of multiple levels of Social Health Insurance, the high growth of the fiscal income and the low growth of the population. The favorable conditions made the health insurance work launch conveniently, which made ZhuHai City advanced all over the country.2. The stable operation of ZhuHai City Social Health Insurance fund was guaranteed by the Law of ZhuHai City Social Health Insurance against Cheating, the supervision of the ZhuHai City Social Health Insurance Supervision Committee, and the efficient work of the Social Health Insurance Center.3. The systematic dynamics study of ZhuHai City Worker Basic Health Insurance Fund showed: The healthy development of the national economy was the base for the effective operation of the health insurance system; the total increase of the Fund was considered on the premise of emphasizing the medical treatment quality; the coverage of the Social Health Insurance should be enlarged further while effective operation of the Fund being guaranteed.4. The policy-making ideas of ZhuHai City health insurance were different from each other; some part of the City Worker Basic Health Insurance policy was not conformed to the development of the time; there was a low copayment for the inpatients while the level of treatment enjoyed by the insured was too high; migrant population lacked the health insurance, and there was a low degree of the fiscal subsidy to the juveniles and the city and town residents and the insured.5. There were the fee-for service payment for the outpatient expenditure, the payment quota for the inpatient expenditure in ZhuHai City, and the enhancement of the supervision policy to the designated health institutions led to that some of the insured patients have less inpatient daily expenditure than that of the out-of-pocket patient, but the average length of the stay of the insured inpatient was longer than that of the out-of-pocket patient.Suggestions1. The ideas of making Social Health Insurance policy should be unified, and the migrant population should be covered by the Social Health Insurance; different populations should be different in standards on the premium and medical treatment, and there should have a "unified" management of Social Health Insurance.2. The copayment level should be increased for City Worker Basic Health Insurance, and the levels of fiscal subsidy and medical treatment of the City Resident Medical Insurance should be enhanced for the juveniles and the residents in the city.3. The proportion of the drug in the insured inpatient expenditure should be contained; the restriction of the length of the stay for every kind of disease should be strengthened in order to reduce the hospitalization expenditure of the insured patients.4. Measures need to be taken to cover the medical expenditure and enhance the medical treatment quality, such as: the measures on the establishment of the true marketing mechanism for the medical treatment and care system, the reimbursement, the improved payment model, the enhancement of the supervision mechanism of the health insurance fund audit, the reform on the medical payment system, etcThe innovationsof the study1. Introduction of the concept of the coverage of the Social Health Insurance and the calculation method, it has originality2. Systematic analysis on ZhuHai City health insurance model and comparison with other advanced cities, similar researchs have not been found.3. The systematic dynamics study method was applied to analyze the operation of the health insurance fund, it has some innovative.4. The similar domestic study has not been found for the impact study of the medical insurance policy on medical expenditure by the comparison of the expenditure components, daily inpatient expenditure and the average length of stay of the insured and non-insured inpatients.The limitations:1. The investigated sampling was limited to ZhuHai City People Hospital due to restriction of time and project fund. Thus, it was hard for this study to represent the impact of the health insurance policy on the medical expenditure as a whole due to the different scale and rank of the medical institutions in ZhuHai City.2. There was no detailed study of the ZhuHai City health insurance fund collecting model and the fund collecting proportion /quantity, the fiscal subsidy proportion, payment proportion determination due to the limitation of the time and energy. All these need to be studied further.