Research Of Social Medical Insurance System Of The Elderly In Cities And Towns Under The Trend Of Population Ageing

Objective1.To make a survey of the actual medical expenses and their medical insurance,and to investigate their attitude to medical institutions and social medical insurances in the basis of the actual physical conditions and health service demands of the elderly in cities.Then analyzing health status and medical service demands of the elderly in cities and towns of Shaanxi Province.2.Systematically analyzing medical cost burdens and medical insurance status of the elderly in cities and towns of Shaanxi Province.Analyzing the security level of the urban basic medical insurance system to provide basic data and analysis supports to the comprehensive assessment of medical insurances of old people in cities and towns in Shaanxi Province,to further strategic researches coping with the aging of the population,and to provide policy-making suggestions of establishing and perfecting the medical insurance system of the urban elderly.Data and Methods1.Source of data: Data of urban basic medical insurances of Shaanxi Province in 2010-2015,data of the questionnaire survey conducted in cities of Yulin,Xi'an and Ankang in 2014 and official statistics that had been published.2.Analytical method: Data were collated using SPSS21.0 software to analyze status of basic health,chronic diseases,medical insurances and the security level of the elderly in cities and towns of Shaanxi Province.Logistic regression analysis was made to analyze satisfaction degree of the basic medical insurance system and its influence factors.Suggestions for policy makers were made by inductive analysis combined with related policies and statistics of Shaanxi's basic medical insurance system.Results1.Shaanxi had formed an integrated system of urban basic medical insurance consisting of the medical insurance of urban workers and that of urban residents.There had been 12.48 million people in the system of the urban basic medical insurance in Shaanxi,covered 59.15% people in urban areas.2.Characteristics of the urban basic medical insurance system of the elderly were:(1)There were narrow range and low limitation of reimbursement for outpatients' medical costs.(2)The medical burden of urban workers was obviously lower than urban residents on hospitalization cost.(3)The system encouraged graded medical treatment so the reimbursement of hospitalization costs in tertiary hospitals was lower than that of second-class hospitals and primary hospitals.Subjective health status of interviewees was bad with 29.9% feeling healthy.Most of the interviewees had disabilities of sleeping,eyesight,hearing and walking.Various cares were needed by the elderly.3.17.8% interviewees were influenced by abnormal emotions but rarely search for others' help especially helps of doctors(77.0%).4.The morbidity rate of hypertension of interviewees were 43.4%,25.7% for hyperlipaemia and 15.4% for diabetes.Medicine cost of hypertension within the latest 6 months was 1590.6 yuan,1977.3 yuan for hyperlipaemia and 1911.6 yuan for diabetes.Self-paid rate of these costs was high.5.Satisfaction rate of the system of urban medical insurance was 59.5%.Interviewees who lived close to the nearest medical institution,participated in commercial medical insurances,had no physical examinations within one year and had bad subjective health status were more possible to be satisfied with the social basic medical insurance system.6.153 interviewees had diseases 2 weeks before the interview,51 of whom had been to doctors and 102 hadn't.The two-week prevalence rate was 25.9%,the two-week visiting rate 8.6% and the rate of those who should visit a doctor but not was 66.7%.159 interviewees had been in hospital within one year and the rate of hospitalization was 26.9%.93 interviewees should have been in hospital and the rate was 36.9%.7.The average medical cost within the latest 2 weeks was 1261 yuan,with the average reimbursement rate of medical insurance 19.9%,and 73.2% self-paid.8.The latest inhospital treatment had an average of 16.7 days and 11168.9 yuan,for 668.8 yuan per day.The rate of self-paid cost was 22.0%,and 59.2% of medical insurance.51.6% felt under great burden about self-paid hospitalization costs.Conclusion and Suggestions1.Most of the elderly in cities and towns of Shaanxi Province were covered by the basic medical insurance system,so their basic medical needs could be met.But the rights of those who weren't in the system should not be ignored.2.The rate of those who attended commercial medical insurances was low.Firms which run commercial medical insurances should develop new kinds of insurances,manage honestly,strengthen supervision to improve service level of insurance agencies,get avoid of misleading and exaggerating,and let the governments play their roles to improve commercial medical insurances.3.Shaanxi hadn't established any special medical insurance for the elderly,but experiences of long-term care insurance could be tried combined with the province's actual situations.More insurance should be put forward to expand the range of medical insurance system,including insurances of preventing,caring and recovering which were needed by the elderly.4.Enhance the security level of the basic medical insurance system by improving the reimbursement system of medical costs expend in other places and increasing the reimbursement rate of the costs of outpatients.