A Study On The Reform Of The Basic Medical Insurance System For Urban And Rural Residents In China

In recent years, the state attaches great importance to the medical and health system reform, accelerate the pace of reform for the urban residents medical insurance and the rural cooperative medical insurance, the party’s sixth plenary of sixteen session put forward the words "to 2020 basic to establish the social security system covering urban and rural residents ",which be regarded as an important goal and tasks of building a harmonious socialist society. During the period of "11th five-year plan ", one of the main tasks of our country to reform social security system is to perfect social insurance relationship transfer of insured persons, and to realize the social security system policy effective connection between different groups. Under the support of policy,1 various areas join into the exploration stage which to reform urban residents medical insurance and the rural cooperative medical insurance system. Since 2007, Many places to carry out "urban and rural residents basic medical insurance plan", which is adaptable to the local. Most of the provinces have to carry out the policy so far. After eight years of exploration, urban and rural residents basic medical insurance mechanism gradually mature, but the system have many difference between different areas, which hindering the urban and rural residents health to realize the higher levels of the work. To accelerate the reform of urban and rural residents medical insurance, it is a key issue to having comprehensive understanding and analysis of the e present situation and the operation mode of urban and rural residents medical insurance.This paper through the literature research, adopt the qualitative method to summary and understanding the implementation and characteristics of China’s urban and rural residents medical insurance status; Secondly, the research sample is the 78 pilot areas have been checked, using quantitative research methods, to analyze and understand the operation of the regional urban and rural residents basic medical insurance in our country comprehensively. And to summarizes the operation modes and rules of the urban and rural residents medical treatment insurance system in our country. At the same time, to analyze the existing problems of it, and puts forward corresponding suggestions, to provide reference for the next step to carry out the system.The research main contents:to explore the theoretical basis of the basic medical insurance system for urban and rural residents; Combing the changes of reforms of the urban and rural residents basic medical insurance system; to summary the present situation and characteristics of China’s urban and rural residents basic medical insurance system, including five aspects:the pilot region of distribution of the urban and rural residents basic medical insurance. And the mechanism of financing, compensation, management and administration; Combined with the present situation of each pilot areas, to analysis the difficulties and problems of medical insurance system of urban and rural residents. Finally putting forward to the policy suggestions on further perfecting the urban and rural residents medical insurance.Research main conclusions:(1) most provinces have carried out the pilot work of medical insurance system of urban and rural residents, and work in the east have been promoted faster. But most of the regions has yet to start the implementation of urban and rural residents medical treatment insurance, and there are big differences of the running mechanism.(2) Most of the pilot areas of the country’s medical insurance fund has realized a city as a whole, but it have two kinds of patterns. One of the model is "city-level unified collection state", another is "city as a whole, hierarchical management". At present, China’s urban and rural residents basic medical insurance fund an obviously low level as a whole.(3)There is a difference between the financing method for urban and rural residents basic medical insurance. There is a large difference between the personal financing, which is divided into many grade and standard. On the funding level, there are many differences in different areas of the proportion of individual pay and the government subsidies and standards. At present, it has yet to form a standardized and rational financing mechanism.(4) There are different compensation mechanisms across the urban and rural residents basic medical insurance. Some areas to take "in the hospital as a whole and individual account", the other areas are " in the hospital as a whole and outpatient service as a whole". The hospital compensation of the starting line, the top line, compensation mode and level is different. The outpatient compensation pattern is diversit it also has different starting line the top line and compensation ratio. Medical insurance in urban and rural residents around the compensation mode and the effect on each are not identical.(5)The medical insurance of urban and rural residents have different medical insurance management department, some is the department of health management, some is the management of social security branch, and the joint management by the department of health and social security department. The government needs to clear the unified competent department of urban and rural residents basic medical insurance.Finally putting forward policy suggestions based on our country urban and rural residents medical insurance:to further expand the pilot and sum up the experiences of successful pilot areas; To strengthen the government responsibility, improve the unity of the system of urban and rural areas and between regions; to raise funds as a whole level and enhance the support capability of fund; to establish a standardized scientific financing mechanism and unified the fiscal subsidy standards; To improve the compensation structure and the level of compensation and effect; to make the department of social security to manage the Urban and rural residents medical insurance.