Research On The Sustainable Development Of Maternity Insurance Fund From The Perspective Of Institutional Change

For all countries in the world,maternity insurance system is important to ensure the reproduction of human life,and its changes ensure the sustainable development of human civilization.In 1982,China launched the one-child policy as a family planning tool to control the domestic population growth,so as to avoid all kinds of negative burdens and consequences brought by excessive population growth to China at that time.Since 1949,China's fertility policy has undergone four periods of changes: the first stage is the period of encouraging childbearing from 1949 to 1953;the second is the loose family planning stage from 1954 to 1977;the third is the strict family planning stage from 1978 to 2013;the fourth is the relaxation of family planning stage since2014.This shows that the policy has become the basis for the design of the existing maternity insurance plan in China.Nowadays,with the changes of the fertility policy system,the implementation of the comprehensive two-child policy has posed a major challenge to the sustainability of the maternity insurance fund.Moreover,the incentive fertility policy is likely to appear in the future,which will pose a greater threat to the sustainable development of the maternity insurance fund.If the sustainable development of the maternity insurance fund goes wrong,it is likely to lead to a series of serious problems,such as the decline of the birth population and the aggravation of the aging of the population structure,which will form a vicious circle.In view of the above background,this study aims to ensure the sustainable operation of maternity insurance fund in the process of institutional change to adapt to the new population policy,that is to say,how to maintain the sustainable development of maternity insurance fund under the background of national population policy changing from strict family planning stage to relaxing family planning stage and even encouraging birth stage.The research solved the following three questions:(1)by constructing a theoretical model for the sustainable development and change of the birth insurance system,the process of the change maternity insurance system was visualized from the theoretical point of view;(2)by using the grounded theory,the influencing factors of the sustainable development of the maternity insurance fund were refined,analyzed and summarized,and the relationship between these factors and the sustainable development of the maternity insurance fund was finally revealed;(3)by using the method of system dynamics,a universal sustainable development model of maternity insurance fund was constructed and meanwhile,taking Jiangsu Province as a sample,the sustainable development of maternity insurance fund under the current and the future maternity insurance system was discussed.The research ideas of this thesis were developed as follows:(1)on the basis of combing the history of the development and change of the maternity insurance system in China,the dynamic change model of the maternity insurance system was summarized and analyzed;(2)taking reference to the dynamic change model of maternity insurance system,and on the basis of literature review and interviews with experts,the factors influencing sustainable development of the maternity insurance fund were refined and analyzed by using grounded theory,and finally the mechanism how these factors work was revealed;(3)based on the dynamic change model of the maternity insurance system and the qualitative research results of the factors of the sustainable development of the maternity insurance fund,the sustainable development model of the maternity insurance fund under the current system and the future insurance system was constructed by using system dynamics;(4)finally,through the data demonstration and simulation,the sustainable development strategy of the maternity insurance fund was found to ensure and support the successful transition of the maternity insurance system,the smooth implementation of population policies such as the comprehensive two-child policy,and the possible implementation of fertility incentive policies in the future.The main conclusions of this thesis are as follows:Firstly,it is found that how to reform and maintain the sustainable development of the maternity insurance fund is the core of the four-step cycle of the maternity insurance system dynamic change.Based on the theory of institutional change and sustainable development,the dynamic change cycle of maternity insurance system was summarized and analyzed.Specifically,the cycle process of the institutional dynamic change is as follows:(1)with the development of the times,a new crisis caused by external factors such as aging population;(2)the development of the maternity insurance fund is unsustainable led by the new crisis;(3)the maternity insurance fund is reformed and evolved;(4)the maternity insurance system maintains phased sustainability until next crisis.Secondly,seven core categories of the factors influencing the sustainable development of the maternity insurance system were summarized by using grounded theory.These core categories include institutional change,operation of maternity insurance fund,financing of maternity insurance fund,expenditure of maternity insurance fund,coverage degree of maternity insurance,fertility willingness and operation status of medical insurance fund.These core categories are the most important factors affecting the sustainable development of maternity insurance fund.Finally,suggestions for the sustainable development of the maternity insurance fund and the successful change of the maternity insurance system were proposed by combing with the above research conclusions and the results of system dynamics simulation,such as reasonable birth incentive policy and specific amount of fertility incentive strategy,scientific setting of maternity insurance fund payment rate,establishment of scientific and reasonable dynamic financing mechanism of maternity insurance,ensuring the direction of institutional change,improving the overall level and expanding the coverage of insurance,improving the supervision of the fund,and building a birth support system and so on.