Study On The Cost Sharing Ratio Of Hospitalization Expense In The Basic Medical Insurance For Urban Employees In Shanghai

In recent years, a large number of fund balance is a problem in the basic medical insurance for urban employees in C hina, whereas it is failed to effective use of the medical insurance fund, the present problem of the difficulty and expensiveness in medical services still exists. The overabundance of fund balance is mainly due to the unreasonable fund policy design. In order to ensure the long-term balance of the funds and promote the rational use of funds, this paper focus on analysis of policy design on consolidated fund and the insured cost sharing ratio of hospitalization expense from the perspective of fund expenditure policies, based on an overall analysis of the effect of economic, demographic and other factors in the future.Taken Shanghai as an example, this paper select the cost sharing ratio of hospitalization expenses in the basic medical insurance for urban employees for the research. First of all, it researches literatures at home and abroad about the cost sharing ratio of hospitalization expenses in theory and practice; This paper introduces the history of the basic medical insurance for urban employees, and it analyses the situation and problems of the cost sharing ratio of hospitalization expense between consolidated fund and the insured in Shanghai; Then it puts forward economic, population and medical factors which influence cost sharing ratio of hospitalization expenses in the basic medical insurance for urban employees; To find out the key adjustment parameters, this paper establish a impact model of three parameters(deductible, co-insurance and top limit) that influence the total hospitalization expense s, and it conducts sensitivity analysis of the three parameters that influence the the average total hospitalization compensation expenses respectively; It establishes a dynamic balance model on consolidated fund; It poses three plans about the cost-sharing of hospitalization expenses in the basic medical insurance for urban employees in Shanghai in the future. With the premise of the dynamic balance model on consolidated fund, it test the result of three plans; Finally, this paper propose some countermeasures and suggestions for adjustment of the cost sharing ratio of hospitalization expenses in the basic medical insurance for urban employees in Shanghai.This paper uses insurance actuarial method and gray system prediction method. The main points of the paper are as follows: First, the sensitivity of top limit is highest, secondly co- insurance, and the sensitivity of deductible is lowest as the result of the sensitivity analysis of three parameters(deductible, co- insurance and top limit); Second, through the establishment of the dynamic balance model on consolidated fund, the dynamic rate of balances could be around 0~5%; Lastly, this paper poses three plans that focus on adjustment of co- insurance and top limit, and tests three assumed values and determines the reasonable values with the premise of the dynamic balance model on consolidated fund.