Studies On System Of Basic Medical Care Security Under Urban And Rural Coordination Based On The View Of Institution Framework Construction

The Chinese medical care security system has been formed and developed since the foundation of New China. The system has been short of unity between urban and rural areas due to such causes as disparity between urban and rural economic development, which shows different features and development process. The urban areas have witnessed various medical insurance systems such as medical care of labor protection, public medical care, reform and pilot of medical insurance of urban areas, nationwide basic medical insurance for urban employees, basic medical insurance for urban for urban residents. Meanwhile, after the rural areas have experienced several medical insurance systems including the old cooperative medical insurance system, the new cooperative medical insurance system, we began to further explore and improve the system. With evolution of Chinese medical insurance system, China has entered stage of medical insurance covering all people with formation of three basic medical insurance systems including basic medical insurance for urban employees, basic medical insurance for urban residents and the new cooperative medical insurance for rural residents.With socio-economic development and widening coverage of medical insurance, the co-existence of different medical insurance systems that are unfair between urban and rural areas, can not meet requirements of social development and people security, hindering development of medical insurance. What are reasons behind the problem? How to integrate the existing medical insurance systems and administrative resources from perspective of fairness and efficiency? Is it economically feasible at present stage for Jiangsu Province to follow the reform idea of coordination brought forth by central government? How to stipulate specific system of urban and rural coordination of medical care security?The dissertation studies on basic medical care security system of Jiangsu Province in an effort to present a feasible framework for Jiangsu Province. It has been proven in practice and theory that it is now possible for Jiangsu Province to implement a unified basic medical care security system for both urban and rural areas. The dissertation is consist of eight parts. Below are main research results.Partâ… Existing problems of current basic medical care security system in Jiangsu ProvinceBased on survey and research, analyzing by the method of Health Systems Diagnostic Tree, the dissertation points existing problems of current system of basic medical care security system in Jiangsu Province, including the following aspects of funds-raising, administration and reimbursement.At current stage, great changes have taken place in rural areas of Jiangsu Province in terms of social structure. The three basic medical insurances are designed on different principles of cities and rural areas, and the participants are based on personal identification, which can not meet the requirements of medical insurance from people with different income levels, goes against the trend of social development as well. Because of the low level of coordination, the funds-raising standards vary greatly from one city or county to another, which results in unfairness of funds-raising in different areas. Especially the enormous gap in funds-raising level and financial subsidies of south, middle and north of Jiangsu Province causes more financial pressure to people with lower income, which is against their benefits. Besides, unreasonable funds-raising scheme undermines risk resistance capacity of medical insurance funds. At present, the three basic medical insurance systems of Jiangsu Province are principally arranged at city or county level. For most regions, there are several administrative departments in charge of medical care security system. While the department of labor security is responsible for basic medical insurance system for urban employees and residents, the department of public health care administers new cooperative medical insurance for rural areas, which causes much inconvenience in administering the three basic medical insurance systems, improves administrative cost, reduces administrative efficiency, and finally prevents people from getting access to basic medical care security equally. From the point of the reimbursement level, the current medical insurance systems have crossed coverage and security objects. Complicated insurance patterns exist in different regions. Moreover, different local financial conditions results in an enormous gap in terms of coverage in different regions. As a result, residents can not get equal access to basic health services, contrary to the principle of fairness and reduce the enthusiasm of insured.Depends on the analysis above, the dissertation proposes the necessary of urban and rural coordination of medical insurance.Partâ…¡The urban and rural coordination of basic medical care security system has raised regional medical insurance and the benefit level.In the dissertation, a theoretical model is used to illustrate that the urban and rural coordination of medical care security system can bring benefits in three aspects. At first, the fund management functions of the new cooperative medical insurance for rural residents are separated from the health sector, so the third parties can play more effective regulatory functions. Though the improvement of payment and mechanism of negotiating, it can effectively control the induced demand and moral hazard of the doctor as well as the unnecessary medical consumption and the price of medical services which enhanced the welfare of consumers. At second, the coordination can improve the reimbursement for the medical insurance. So it can effectively share parts of the burden of health care of insured. At last, the integration of the administration for urban and rural areas is propitious to reasonably integration and effectively use the management resources, such as human, finance, material and so on. It can also lower the duplicate insurance issues which caused by the division of information systems. It can reduce the difficulty of the health care work, management costs. All of these can raise the treatment of the health care and the overall level of benefits of insured.Based on field investigation in Jiangsu Province, the dissertation employs positive method to prove that given funds-raising standard and maximum reimbursement, the security rate in places where urban and rural medical insurances are administered by identical departments is 8.13 percent higher than that in places where urban and rural medical insurances are administered by different departments.The unity of basic medical insurance administrative departments can raise efficiency, reduce resource waste. It indicates that the urban and rural coordination of medical care security system can solve some problems in the current medical care security system in Jiangsu during the operation.Partâ…¢Verify that whether Jiangsu Province is able to implement the coordination for basic medical care security system for urban and rural areas at present stage.Because of the regional difference in Jiangsu province, there're large gap in regional economic development. Generally speaking, the economic in the south regional has been better than it in the north. According to the economic development, it's been divided into three regions:the north regional of Jiangsu, the middle regional of Jiangsu and the south regional of Jiangsu. Although the urban and rural coordination of medical care security system is an alternative solution, whether it can be done in this place with a gap in economic development remains to be verified. We will explore in detail main obstacles facing the urban and rural coordination of medical care security system in Jiangsu Province from such four viewpoints as finance, urban-rural income gap, fairness of resource allocation and transfer continuum of medical insurance.From perspective of relationship of economy and coordination of medical care security system, when GDP per capita has reached a higher level in Jiangsu Province, it is feasible for the province to implement urban and rural coordination of medical insurance in spite of relative disparity of economic development. In consideration of disparity and correlation of urban-rural income, it is necessary to establish an indiscriminated, tailor-made system of medical insurance that fits for all people. Jiangsu Province has taken the lead in terms of fairness of medical resource allocation. With the condition that the fairness is gradually enhanced, the province can pioneer to implement the urban and rural coordination of medical care security system in China. At present, Jiangsu Province has piloted the program of "to receive medical service out of one's hometown". It will be implemented in whole province in short term, which will provide a foundation for system and settlement platform of urban and rural coordination of medical care security system.The analysis of these factors indicates that Jiangsu Province is able to implement the urban and rural coordination of basic medical care security system at current stage.Part IV Basic ideas on urban and rural coordination of basic medical care security in Jiangsu ProvinceThe design of medical care security system is mainly related to two issues: funds-raising and reimbursement scheme. The principles of design should follow the minimum efficiency loss and the most equitable form of organization. It should not result in the inflated medical expenses, and should effectively solve the medical burden of insured residents. Through the calculation, the standard of funds-raising and reimbursement scheme of different combinations of health insurance contracts is as followed:the criteria of personal funds-raising scheme of selective health insurance contracts of class A is 350 yuan (include serious illness insurance). The total amount of the corresponding payment base set at 1750 yuan. The corresponding rates of reimbursement should also be increased to 75%-80%. The minimum reimbursement set at 400,600,1000 yuan and the maximum reimbursement set at 180000 yuan. The rates of reimbursement of class B should be increased to 50%-55%. The minimum reimbursement set at 300,500,1000 yuan and the maximum reimbursement set at 100000 yuan. The criteria of corresponding funds-raising scheme should be set at 400 yuan:200 yuan is for the person, and the rest for the government. The criteria of personal corresponding funds-raising scheme of class C should be set at 60 yuan and the rest 200 yuan is for the government, so the total is 260 yuan. The corresponding rates of reimbursement should also be increased to 35%-40%. The minimum reimbursement set at 300,450,1000 yuan and the maximum reimbursement set at 70000 yuan.On basis of studying at the income levels of social group and their demand for health insurance, a basic idea of framework for urban and rural coordination of basic medical care security system is put forward in the dissertation, which is characterized by multiple level, free option, whole coverage, coordination at province level, suitable security.