Studying The Calculation Of Catastrophic Medical Insurance Of Urban And Rural Residents In Ningxia

Background: The catastrophic medical insurance system was maked in August 24, 2012,after that many pilot cities begin to implement it,calculation of the definition of catastrophic threshold,financing etc on the basis of commercial insurance companies participate in the management can contribute to explore more reasonable and effective catastrophic medical insurance system,and better to integrate medical needs, provide a theory basis for improving the efficiency of medical insurance.Objective:According to analysis the basic situation of catastrophic medical insurance of urban and rural residents in Ningxia and the implementation status of the county in pilot city, adopt the method of the World health organization(WHO) catastrophic medical expenditure and the average income method of poverty line to calculate the definition of catastrophic threshold of catastrophic medical insurance, based on the benefit of insured person determine the definition of catastrophic threshold,then calculate the financing under the condition of commercial insurance company Participate in management,exploring more reasonable and effective catastrophic medical insurance system with implementation of the county.Methods:Analyze the basic situation and implementation status of the county with statistical and descriptive analysis method, calculation the definition of catastrophic threshold with WHO catastrophic medical expenditure method and the average income method of poverty line,use the cost estimation model of ILO model to calculate the financing, use the four-part model to calculate catastrophic medical expenses, use estimate method to calculate the individual funding, the method using reference estimate insurance factor and risk funds,use ratio method to calculate the growth factor,use personal interviews and expert consultation to calculate the management costs of commercial insurance companies.Results:1.The catastrophic medical insurance of urban and rural residents in Ningxia definite the conception of catastrophic disease with high medical expenditure based and consider 20 serious diseases, the individual funding is 28 yuan per person per year,the deductible both urban and rural residents are 6000 yuan,in different areas with different compensation standard. The benefit of rural residents are lower than other residents,and have quite different compare with urban residents.The catastrophic medical insurance reduce some medical expenditure burden of urban and rural residents,but the rural residents have more than 3 times economic burden than the urban residents.2.Based on the WHO catastrophic medical expenditure method,the definition of catastrophic thresholdⅠ of urban residents is 16690.00 yuan,rural residents is 5370.00 yuan. Based on the average income method of poverty line, the definition of catastrophic thresholdⅡ of urban residents is 5563.33 yuan,rural residents is 1790.00 yuan. The definition of catastrophic thresholdⅡare better than the definition of catastrophic thresholdⅠin the insurance coverage, compensation level and the coverage of 20 serious diseases by compare with them, Finally determine the methed of calculates is average income method of poverty line.3.The catastrophic medical expenses of urban and rural residents is 6683831.92 yuan, urban residents is 374511.28 yuan,rural residents is 6309320.64 yuan. The management costs of People’s Insurance Company of China is 207400.00 yuan per year,the China Life Insurance Company is 495000.00 yuan per year, correspondingly,the total funding of urban and rural residents is 3943100.45 yuan and 4230700.45 yuan,the individual funding of urban residents is 8.81 yuan and 10.04 yuan,rural residents is 16.88 yuan and 17.02 yuan, urban and rural residents is 16.05 yuan and 16.17 yuan.4.Compared the measure scheme results with the current scheme will find in the measure scheme the scope and level of benefit in rural residents are improved, and the gap between the residents in urban from 150.32% reduce to 23.83%,the measure scheme calculate for different groups and increasing the utilization of funds with the principles of "expenditure is determined by revenue" to ensure the effectiveness and fairness of catastrophic insurance for different groups.Suggestions:1.According to different groups make a more detailed definition of catastrophic threshold on local conditions.2.Further optimize the 20 kinds of catastrophic disease to determine a more appropriate level of insurance for disease.3.Constantly improve its funding compensation mechanism make a more detailedness scheme based on the situation of definition of catastrophic threshold, risk of catastrophic, benefit, economic burden for disease,the balance rate of fund.4.Broaden the financing channels for catastrophic insurance and establish a reasonable funding mechanism of catastrophic insurance which suitable for the level of economic.5.The rural residents be at higher risk of catastrophic disease, so they are the key groups in the catastrophic medical insurance.6.Make the profit fee of commercial insurance companies in a reasonable range and give full play to their capabilities to control medical risk.