Exploration On The Sustainable Development Of Residents Medical Care Fund Of Changshu City

The residents' medical insurance of Changshu is a medical insurance system for urban and rural residents to provide medical insurance.Our total medical expenses in 2011 than in 2010 increased by 9.56%,2010 and 2011,the fund utilization rate reached 96.43% and 99.93%,the fund runs are facing greater pressure and risk.Then,the Residents health insurance of Changshu make more efforts for the fund to sustainable development.However,in recent years the reasons leading to the rapid growth of the total medical costs of residents health insurance.Objective: The number of residents insured by 524424 in 2011 decreased to 408703 in 2015,over 60 years of age accounted for the proportion of the total number of insured persons from 35.45% in 2011 rose to 39.74% in 2015.The decline in the total number of insured population will seriously affect the total cost of health insurance fund,the proportion of elderly people accounted for the proportion of insured population will increase the pressure on the health insurance fund.In view of the current residents medical insurance fund is facing pressure,according to the existing data for measures,without increasing financing standards,to maximize the benefit of the insured,and can have a positive impact on the sustainable development of medical insurance fund.Materials and methods: To collect relevant data by literature research and information research methods,utilization of health services of resident population,the health services utilization,hospitalization fund expenditure and the burden of disease of residents Medicare insured including 2011-2013.Results: 2011-2013 year,the proportion of residents' health insurance fund expenditures accounted for the proportion of the fund's income remained at more than 90%,about 16 percent of the total number of hospital visits using more than 76% of the total fund.2011-2013 years,residents medical insurance in the hospital expenses increased year by year,in 2013 the growth rate even reached 6.5%,accounting for the total number of hospital visits to the total number of trips accounted for a small amount of special funds accounted for a total.2011 to 2013,inpatient rate of residents Medicare insured of Changshu always of high 2%-3% than the resident population(including the Changshu workers' medical insurance,residents health insurance and a handful of foreign uninsured personnel and no health insurance personnel),and the rate of hospitalization increased year by year.In the flow of medical treatment,residents health insurance is more likely to choose the hospital for medical treatment than the resident population.2011-2013,respiratory system diseases,digestive system diseases,circulatory system diseases and tumors of the four classification of diseases both in the total hospitalization expenses of hospitalization or in the total number of all are in the top four classification of diseases,tumor is the four in the classification of diseases with the highest average fee,the average expense in 9 thousand yuan.Conclusion: we need to promote the proper adjustment of residents' health insurance compensation policies,including the implementation of day surgery in the designated medical institutions according to hospitalization compensation settlement policy,improve part of chronic disease in outpatient compensation fund,using the third party to strengthen the daily supervision of designated medical institutions and compensation settlement linked to the commercial insurance sector and expand serious illness supplementary insured people,makes the patient to rationalization;strengthen the prevention of respiratory system diseases,digestive system diseases,circulatory system diseases and tumors of the four classification of diseases,especially tumors screening programs increase two aspects to control the increase of total medical cost.The proposed adjustment fund compensation policy and strengthening the heavy burden of disease prevention and control measures,to maximize the residents Medicare insured benefit,and can produce a positive impact on the sustainable development of residents' health insurance fund.