Evaluation Study On The Effects Of Integrating Urban And Rural Residents Basic Medical Insurance Systems In Shandong Province

BackgroundSince the foundation of the PRC,the basic medical insurance system of our country has been established on the basis of the difference between urban and rural economic and social development,and the system construction presents diversified and fragmented characteristics.With the development of social economy,the inequality between urban and rural areas brought by different medical insurance system is becoming more and more prominent The Urban Basic Medical Insurance System and New Rural Cooperative Medical System are divided into different management departments and have a gap in raising funds and reimbursement levels.This is not conducive to the embodiment of health equity between urban and rural residents,and also not conducive to the sustainable development of social security system.Integrating the basic medical insurance system of urban and rural residents becomes the inevitable of economic and social development.To this end,the State Council and the 18th National Congress of CPC have proposed the integration of urban and rural health care system development requirements.And in 2016,The State Council has introduced concrete suggestions to all provinces to made clear stipulation and deployment of the integration of urban and rural residents’ health insurance systems.Shandong province began to carry out the integration of the urban and rural residents’health insurance system from 2014,and began implementing the new resident basic health care system in 2015.In order to summarize and analyze the problems of the integration in a timely manner,further perfecting the system of health care integration and innovating mode,it is necessary to evaluate the integration process so that we can safeguard the health and sustainability of the health care system of urban and rural residents.Significance and ObjectiveThe systematic evaluation of the integration effect of the health insurance system of urban and rural residents in Shandong Province is intended to summarize the effect of the integration of health insurance in Shandong Province,discover the problems in the process of system integration,and provide strategic suggestions for the further improvement of health care integration in Shandong Province,which is of great significance to the Residents’ health care system.At the same time,through studying the evaluation index system of the medical insurance system integration,it can compensate the current vacancy of the system evaluation study of the urban and rural residents’ health insurance systems integration and provide the basis for the integration evaluation of urban and rural health insurance systems in other provinces.The main purpose of this study is to construct evaluation index system,systematically evaluate the construction,implementation and effect of the integration of the health insurance systems for urban and rural residents in Shandong province,clarify the concrete results and problems of the integration,and provide policy suggestions for perfecting the health care integration work.MethodsThe construction of Evaluation index system was accomplished by"Structure-Process-Outcome" theory Delphi inquiry method and analytic hierarchy process.Based on the progress of economic development and the integration of health insurance in urban and rural areas,the study extracted 5 samples from Shandong province.By using stratified random sampling method,we chose the medical insurance management agencies,health care institutions and the family of insured residents,and carried out questionnaires and interviews to obtain the necessary data.Results1.Result of the construction of the appraisal index systemThis study has constructed the evaluation index system which consists of three first-level indicators,11 second-level indicators and 30 tertiary indicators.2.Result of the effect evaluation on the integration of health care systemsJudging from the overall evaluation results,Dongying’s Total score of effect evaluation is above 0.80 points,the remaining 4 cities are above 0.75 points.In the shorter integration time,the urban and rural residents’ health insurance integration of Shandong Province has achieved certain results.The indicators of system construction get a relatively high score.The indicators of system implementation and system implementation effect get a relatively low score.Judging from the comparison of the results of the sample cities,Dongying overall score is highest;Jining’s overall score is lowest,and 16.33%is lower than the highest in Dongying.The overall score gap between the sample cities is larger.Among the sample cities,indicator scores of the system construction are about the same,the difference is not large;the Indicator scores of System Implementation have a certain disparity;the indicator scores of system implementation effect disparity are big.Discussion and RecommendationThe integration of health insurance of urban and rural residents in Shandong province has achieved a certain effect on the whole,however,there are still many problems needing to be solved in the current health insurance integration.In the construction aspect of integrated system,the management system and the basic system construction are complete,but the construction of the management system of Medicare is imperfect,the management system of Critical Illness Insurance is not straightened out with the basic medical insurance’s.In the implementation aspect of integrated system,the basic system is implemented better,but there are differences in the implementation of the system among cities,the fund management and supervision system are absent,and the fund operation is risk.In the aspect of system implementation effect,the system coverage is comprehensive and insured residents generally benefited with high satisfaction.But the health insurance system has insufficient guiding role to shunt the resident medical service,the excessive growth of medical expenses decreases the role of health insurance system against the economic risk of disease and esidents ’ cognition of Medicare system is impercipient.Recommendation:Strengthen the construction of medical Insurance management team,Straighten out the management system of Critical Illness Insurance,Strengthen the supervision of the operation of Medicare system,strengthen the policy guidance of medical care system to the medicine service,and enlarge the propaganda of medical insurance.