Research For Urban Workers’ Outpatient Insurance In China

With a long period reform of Chinese public medical insurance system, there has achieved enormous results. In order to further improve this security system and enhance the utilization efficiency of employees’ medical insurance fund, with ensuring a higher level for the workers’ medical care, also promoting cohesion and coordinated development of outpatient medical security between workers’ medical insurance system and the other medical insurance system, this article concluded and discussed two forms of workers’ outpatient insurance model, then give the suggestion that how to design urban workers’ outpatient clinic security form based on the overall insurance framework design. Article is divided into four parts, specific research ideas and framework arrangement is as follows:Chapter one is the preamble. In this part, the author introduces the background and significance of the research, and put forward some important concepts and the object of this study. And then, the author gives a brief literature review in the same domain.Chapter two is about the choice of model for workers’ outpatient medical insurance model. First of all, the author concluded two basic outpatient insurance forms(overall security pattern and individual account guarantee mode) through analyze in compare four types of medical insurance model in the world and briefly introduce the foreign two clinics operating condition of this two outpatient insurance pattern. Then, the author looks back upon China worker outpatient insurance historical evolution. After that, author focus on the analysis for three issues of current worker outpatient insurance existed:first, benefited range of the system, the worker outpatient insurance, is low and the fee mainly assumed by individuals; Second, individual account fund balance is overmuch, not fully exerting security role; Third, outpatient fee is overgrowth, and worker’s economic burden for medical service is heavy. Finally of this chapter, the author presents the viewpoint that China worker outpatient insurance shall take overall security pattern, namely overall patient for basic medical clinic analyzing the necessity and realistic significance for the patient overall implement.Chapter three comments about China worker patient insurance overall pilot plan. Through empirical analysis, this chapter researches different patient insurance overall scheme, introducing three representative cities (Zhenjiang, Guangzhou and Wenzhou) in details to analyzes the characteristics of pilot scheme. At the end of this chapter, author tried to make a conclusion about some announcements in design workers’ patient insurance framework. There are three tips of experience as follows:first, in the outpatient insurance as a whole frame design, it ought to be considered the impact of current mode of the workers’ outpatient insurance model, and it may be better if incremental reform be taken to improve workers’ security level under existing funding level; Second, in the design of workers’ patient overall insurance framework, it should through light on giving incentive to medical insurance participation body(medical service supplier and the buyer), taking change from passive to active constraints regulatory; Third, to design workers’patient insurance overall framework design, in order to improve workers’medical treatment to ensure a level, not only need to notice the distinction between inpatient and outpatient, but also the relevance. All of these three tips supply a basis to next chapter.Chapter four claims the realistic route and the construction of works’patient overall framework design. So it normally contains two parts:At first, based on the practice exploration of the works’ patient overall framework in the previous chapter combining with the principle of social security, and fully considered characteristic of patient treatment, author proposes four principles to the works’ patient overall framework design; Secondly, according to common content in the medical insurance system, this chapter design the patient overall framework from fund collection, payment, scope of protection to supervision and management etc.