Designing For The System Of Basic Medical Insurance For Urban Workers In Dalian

With the deepening of national health care reform, Dalian City has implemented the urban basic medical insurance general outpatient co-ordinate system since2014. At present, the implementation of Dalian Medical Insurance System has been faced with the following problems:higher costs of outpatient treatment bring patients more economic burdens; first-class hospitals are overcrowded, the medical resources in organizations at the grass-roots level are unused and wasted; basic medical insurance funds are in shot, but funds of individual accounts are deposited, medical insurance funds have not been fully utilized. In view of above problems, this paper designs a reasonable general outpatient co-ordinate payment program according to the actual clinic situation in Dalian, so as to control the excessive growth of average outpatient costs, promote the rational allocation of medical resources in Dalian, and improve the service efficiency of medical insurance funds.The main contents of this paper include the following aspects:(1)For the foreign workers ’basic medical insurance premium co-ordinate system of general out-patient study and make a summary and analysis of the relevant research;(2)Through analyzing the current situation of implementation of China’s outpatient service overall planing system and combining the situation in Dalian and relevant policies, it confirmed that the common outpatient service consolidate fund in Dalian was transferred proportionally which was established the limited line instead of being established the starting payment line. The hospital treatment expenses were reimbursed proportionally according to the payment system of the outpatient service fond. The overall planning outpatient service fund was paid in capita.The insured employees could select the designated institutes for treatments;(3)According to the project design thought, it analyzed the current basic overall planning statistics of the worker outpatient services in Dalian and estimated the age structure of the patients in the outpatient services in Dalian, the situation of the outpatients’treatments, the level of the medical expenses and the receipts and disbursements of the outpatient service overall planning fund;(4)It adopted the model analysis method and empirical study to make the overall planning outpatient service scheme of the basic medical insurance for workers in Dalian. It also analyze analyzed and evaluated the simulated results of the scheme;(5)It adopted the model analysis method and empirical study to make the overall planning outpatient service scheme of the basic medical insurance for workers in Dalian. It also analyze analyzed and evaluated the simulated results of the scheme.