A Study On Medical Insurance Payment For Shanxi Urban Employees

The problem of medical insurance is a world hard nut. Medical insurance system should ensure participant's health effectively. On the other hand, it also demands to keep the medical insurance expenditure within an acceptable range, keeps the balance between fund's revenue and expenditure, avoids financial crisis, so as to affect sustainability of medical insurance system and participants'health.Medical insurance payment is an important part and an effective way to achieve the security function. In 1999 Shanxi Province established a medical insurance system for urban employees, after 10 years of operation, it has made some achievements, but "heavy cost" is still a strong problem reflecting serious livelihood of urban resident. One major reason is the unscientific payment mechanism, medical insurance paid by service incentive-induced demand for medical insurance agencies act, resulting in a huge waste of medical resources.In this paper, the results of existing research and relevant theoretical generalization, as well as the comparative study of different medical insurance payment are the foundation stone of research. Through the induction and evaluation of Shanxi existing urban employees medical insurance payment policies, and empirical analysis of medical fund revenues and expenditures, health guarantee, the burden of personal medical expenses, pointing out that the current Shanxi urban employees medical insurance payment mechanisms exists"the high cost", personal issues heavy burdens such problems.With the successful payment experience of home and abroad , find the law and put forward comprehensive medical insurance proposal for Shanxi urban employees payment system. Finally, put forward Shanxi medical insurance payment reform idea, namely of based on the total amount of advances to implement a system mixed pay-by diseases payment method. This has great significance of controling the growth of medical costs in Shanxi. Hoping to better safeguard the interests of insured persons, and improve the construction of the medical insurance system in Shanxi Province.