A Study On New Rural Cooperative Medical Scheme Indemnity Plan In Tongshan County, Jiangsu Province

The aim of the study is to research the New Rural Cooperative Medical Scheme Indemnity Plan in Tongshan county, Jiangsu province, explore the loss distribution of New Rural Cooperative Medical Scheme, combine the policy, theory study and practicing experience, evaluate several indemnity plans, then present suggestion on indemnity plans'adjusting ,according to the plan optimizing result and the changing of loss distribution and premium.The loss distribution and it's study tools in insurance actuarial is used to analysis the loss distribution of New Rural Cooperative Medical Scheme, it is shown that for the farmers in New Rural Cooperative Medical Scheme, their hospitalization counts mostly has an Negative Binomial distribution, and their each hospitalization cost has an Burr distribution. The net premium ensuring the whole medical cost can be calculated by using the loss distribution.Based on the policy, theory study and practicing experience, several indemnity plans are presented, then the TOPSIS method is used to optimize them and the optimized plan is selected, which focuses on high-cost disease, has a deductible, indemnifies in two parts, emphasises on high-cost part, and has a maximum.Finally the indemnity plans'adjusting is simulated, based on the loss distribution predicting and optimizing result. It is shown that if there is no dread disease prevalence, and the indemnity level and policy has no changing, the loss distribution of next year can be predicted by the previous loss distribution and the cost increment rate. Furthermore, it is validated that the Burr distribution can fit the loss distribution of New Rural Cooperative Medical Scheme effectively. Based on the predicted loss distribution and optimizing result, according as the premium, the suggestion of plan adjusting is presented.