| Background:Serious illness insurance for urban and rural residents in Shanghai has achieved certain results.The study of serious illness insurance for urban and rural residents in Shanghai can not only provide the basis for the improvement of serious illness insurance policy in other areas,but also explore the practical problems that may appear in the future development of the current serious illness insurance policy in Shanghai,and put forward improvement measures according to the key factors of the problems,so as to further improve the welfare level of the insured persons of serious illness insurance for urban and rural residents.Under the new normal of national economic development,the rapid growth of serious illness insurance fund is limited,but the national policy requires the continuous improvement of the level of serious illness insurance.Under the background of steady growth of individual financing standard,how to improve the level of serious illness insurance in Shanghai? To what extent? And can it maintain the sustainability of the serious illness insurance fund?Under the background of the national mainstream of paying for serious illness according to the large amount of expenses,Shanghai adopts the method of paying for serious illness according to the type of disease.Which of the two payment methods is better? Which way is more suitable for Shanghai? What is the future development of serious illness insurance for urban and rural residents in Shanghai? The effective answer to the question is of great significance to improve the level of serious illness insurance in Shanghai.Objectives:Through theoretical analysis,this paper explains the policy target of serious illness insurance for urban and rural residents,and the implementation effect of typical cases of domestic serious illness insurance,so as to provide the basis for the adjustment of serious illness insurance for urban and rural residents in Shanghai.The scope of serious illness is defined by large cost and serious illness,and the alternative scheme of serious illness insurance is designed based on the national serious illness insurance policy.This paper constructs a micro simulation model of the current policies and alternatives of serious illness insurance for urban and rural residents in Shanghai,simulates the model to 2025,analyzes the impact of policies on medical expenses,personal medical behavior and government payment compensation,discusses the future development direction of serious illness insurance for urban and rural residents in Shanghai,and puts forward some suggestions on the reform and improvement of serious illness insurance policy for urban and rural residents in Shanghai.Contents and Methods:This study adopts the methods of theoretical research and empirical research,quantitative and qualitative analysis to study and analyze the target positioning of urban and rural residents' serious illness insurance in the multi-level medical security system;The scheme was designed according to the treatment payment for serious diseases and the large amount payment,and the micro simulation model was built to simulate and analyze the operation effect of the compensation policy in Shanghai.It includes:1.Theoretical analysis of serious illness insurance for urban and rural residents.This paper systematically combs the development history of serious illness insurance for urban and rural residents in China and Shanghai,and analyzes the policy objectives and existing problems of serious illness insurance in the medical security system by using the theories of welfare economics,institutional change and anti-poverty.This paper selects the typical cases of national serious illness insurance for urban and rural residents,analyzes the typical cases from the aspects of financing,compensation,scope of security,operation and management,implementation effect,etc.,and compares them with the Shanghai mode,and puts forward their respective advantages and disadvantages,so as to provide ideas for Shanghai to improve the serious illness insurance policy.2.Analysis of the population model of serious illness insurance for urban and rural residents in Shanghai.According to the National Census and sampling survey data,Shanghai Statistical Yearbook and Shanghai elderly information monitoring data,the number and related characteristics of the target insured population of serious illness insurance are predicted and analyzed.Cannot do without the basic medical insurance for urban workers registered residence.According to the current policy,the coverage of serious illness insurance is consistent with the basic medical insurance of urban and rural residents.Therefore,the analysis of insured population for serious illness can't be separated from the discussion of basic medical insurance.As the registered residence registered residence and non-registered residence population are the main factors of university students' insurance coverage,and the particularity of fund raising and payment compensation,the household registration population of the insured population is deducted and the model of university student insurance population is constructed separately.3.Micro simulation analysis of serious illness insurance policy for urban and rural residents in Shanghai.Based on the guidance of national serious illness insurance,the paper defines serious illness according to the treatment of serious illness and large expenses,designs the payment policy of serious illness insurance,and constructs the micro simulation model of Shanghai serious illness insurance policy.Based on the payment and compensation data of Shanghai basic medical insurance,the micro database is sorted and analyzed by using sas9.4 software to simulate the process of medical treatment,medical consumption and medical insurance payment and compensation of urban and rural residents.By changing the relevant parameters of the serious illness insurance policy,the guarantee effect of the serious illness insurance policy running continuously until 2025 is simulated and analyzed.4.Analysis on the improvement of serious illness insurance policy for urban and rural residents in Shanghai.Combined with the results of theoretical and empirical analysis,this paper analyzes the policy from the aspects of the sustainability of serious illness insurance fund,the smoothness of the connection between basic medical insurance and serious illness insurance,and the level of security,and puts forward some suggestions for the future development of serious illness insurance for urban and rural residents in Shanghai.Results:From the perspective of population model,the number of insured population of urban and rural residents in Shanghai registered residence has increased year by year.The number of people under 18 years old and below will be 55.35% of the insured population by 2025.The population aged 60 and above accounted for 27.19% of the target population;The population aged 19-59 accounted for 17.46% of the target population.The number of College Students' insured population fluctuates,ranging from 541500 to 688200.From the simulation results of the current financing policy of serious illness insurance,when the participation rate of basic medical insurance in Shanghai is 97% or 98%,the individual financing standard of basic medical insurance for urban and rural residents is increasing year by year;Compared with other age groups,the financing standard amount of the elderly group(60 years old and above)is relatively higher;The total amount of basic medical insurance fund for urban and rural residents is increasing year by year,and the fund mainly comes from government subsidies;The serious illness insurance fund of the current policy comes from the basic medical insurance fund for urban and rural residents,and the steady increase of the basic medical insurance fund year by year drives the growth of the serious illness insurance fund year by year.From the simulation results of the current policy of serious illness insurance,in terms of payment and compensation,the number of beneficiaries of serious illness insurance for urban and rural residents in Shanghai,and the ratio of the benefit rate of serious illness insurance to the actual payment are increasing year by year.Fund operation: the balance of serious illness insurance fund will increase year by year,and the existing serious illness insurance fund can meet the compensation needs of patients with serious illness.According to the simulation results of the adjustment of the current policy payment proportion,in terms of payment compensation,under the three payment proportions of 60%,70% and 80%,the actual individual payment ratio of serious illness insurance increases year by year.For every10% increase in the payment ratio of serious illness insurance,the actual payment ratio of serious illness insurance will increase by about 3%,and the annual per capita personal expenses will decrease by about 14000 yuan.In terms of fund operation: under 60% and 70%payment ratio of serious illness insurance,under the current financing scale,serious illness insurance fund can maintain normal operation,with a slight balance.Under the 80% payment ratio of serious illness insurance,some annual serious illness insurance funds can't maintain normal operation.From the adjustment of the current policy payment scope,in terms of payment compensation,when the payment proportion of serious illness insurance remains unchanged,and the fully self-funded part is included in the scope of serious illness insurance,the actual payment ratio of serious illness insurance increases by about 3% compared with that when the scope is not expanded.Fund operation: after expanding the scope of payment,the balance of serious illness insurance fund increased year by year,and the serious illness insurance fund can maintain normal operation.From the simulation effect of the compensation of serious illness insurance according to the high-cost standard,the number of beneficiaries of serious illness insurance increases year by year.The actual payment proportion of serious illness insurance is maintained between 16% and 18%,and the amount of expenses paid by serious illness insurance is increasing year by year.After the payment of basic medical insurance and serious illness insurance,the amount of personal expenses increases year by year.In terms of fund operation: when the threshold is 15000 yuan,the expenditure of the serious illness insurance fund is greater than the income,and the balance of the serious illness insurance fund is negative,which increases year by year;when the threshold is 20000 yuan,the expenditure of the serious illness insurance fund is greater than the income in 2023-2025,and the serious illness insurance fund is negative.Conclusions and Suggestions:Theoretical research conclusion: the goal of serious illness insurance for urban and rural residents should be focused on the vulnerability of poverty,and the guarantee should be more accurate to reduce the risk of poverty caused by serious illness.Serious illness insurance is the supplementary layer of basic medical insurance.Under the restriction of economic development level,the integration of medical insurance resources is an effective way to improve the level of serious illness security.According to the shortcomings of compensation by disease type,Shanghai serious illness insurance should pay attention to the large amount of medical expenses outside the scope of protection,and the actual medical expenses borne by the patients.Empirical research conclusion: without considering the population of college students,the proportion of underage population and elderly population in the target population is relatively high,while the proportion of working age population is relatively small,showing the characteristics of more at both ends and less in the middle,which is consistent with the actual situation,Because the basic medical insurance for urban and rural residents does not include the groups who participate in the basic medical insurance for urban workers;With the increase of the target population and insurance rate,the total amount of basic medical insurance fund for urban and rural residents increases year by year.When the serious illness insurance fund is raised by 2% of the basic medical insurance fund,the growth of the total amount of basic medical insurance fund for urban and rural residents will inevitably lead to the growth of the serious illness insurance fund;Under the current financing standard,the compensation of serious illness insurance can be improved within a certain range,such as increasing the payment proportion of serious illness insurance,expanding the payment scope of disease,etc.,so that urban and rural residents can have a higher sense of acquisition of serious illness insurance;Under the current financing standard,compared with the payment according to the high cost,the payment according to the disease treatment of serious illness insurance fund is more sustainable;Under the condition of the same coverage rate and payment ratio of serious illness insurance,from the situation of Shanghai,the payment of serious illness insurance according to disease treatment is more targeted,and the compensation effect of individual payment is better.Policy suggestions: according to the current policy,the payment proportion of serious illness insurance can be increased from 55% to 70%,which can ensure the sustainable operation of serious illness insurance fund under the current financing standards,and reduce the annual per capita personal expenses of serious illness patients by 21000 yuan;In view of the current policy,we can include the fully self financed part of the serious illness expenses into the payment scope of the serious illness insurance.The serious illness insurance fund can meet the compensation needs of the patients with serious illness,and has sustainability;Under the policy of paying compensation for patients with serious diseases according to the treatment of diseases,we should focus on the medical expenses borne by individuals with large expenses outside the scope of protection;Relevant research should be carried out to help effectively identify family economic status and ensure the fairness of serious illness insurance payment. |
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