Research On Operation Mechanism And Protection Effects Of The Major Illness Medical Insurance For Urban And Rural Residents In China

The medical insurance system of all-dimensional, multi-level and wide-ranging has been preliminarily formed in China since the Urban Employee Medical Insurance, the New Rural Cooperative Medical Insurance, and the Urban Residents Medical Insurance had been established. But people's demand of the serious illness security is still high and the problem of "being into poverty by illness" is obvious, due to the basic medical insurance system for a long time to pursue the "basic protection" goal. Based on such background, the major illness medical insurance for urban and rural residents is formed, its innovation in business units, financing systems, protection mechanism and management services attracted many governments made implementation scheme combining with local actual situation. By the end of 2014, China's 31 provinces in mainland all made implementation scheme and the major illness medical insurance finally achieved its goal of full-coverage in 2015. Dozens of insurance companies actively undertook the major illness medical insurance in 327 counties or cities, covering a total of 920 million residents, and approximately 3.45 million patients with serious illness directly benefited from it by the reimbursement rate increased an average of 10-15 percentage points. Undoubtedly, the major illness medical insurance becomes the gospel of patients with serious diseases, it is also a civil engineering focused by the government. However, the major illness medical insurance is something new, in the process of "touch stone across the river", a series of problems are exposed gradually, which will affect its sustainable development. Therefore, analyzing its operational mechanism, finding the problems during the advancing process and offering some suggestions for reference accordingly are play an important role in its sustainable development.Based on the above analysis, this paper is mainly to solve the following five questions:What is the major illness medical insurance? How it works in practice? What effects does it have? What problems does it exist? How to improve it? Along the main line, this paper is divided into five chapters. The first and second chapters are used to solve the first problem. The chapter 3 and chapter 4 separately answered the second and the fourth question. Finally, the fifth problem will be solved by the chapter 5. Specifically, the ideas and main contents of each chapter are as follows.The first chapter is introduction. Including three parts:this article's research background and significance, the domestic and international literature review, and other related issues. Research background and significance mainly explains the reasons why choosing this topic. The domestic and international literature review provides the theoretical basis of this paper. The other related issues research including research methods, innovations and shortcomings, etc.The second chapter is the background knowledge of the major illness medical insurance. Firstly, the author gives a clear definition of three terms:the major illness medical insurance, the basic medical insurance and the real time gross settlement. Secondly, the major illness medical insurance can be divided into three stages according to its development situation:at first stage, it is formed preliminarily; at second stage, it is implemented for wide-ranging; the last, it is in the stage of further perfection. Thirdly, the writer refers that the major illness medical insurance currently has the motive force to propelling.The third chapter discusses the operational mechanism of the major illness medical insurance. Although the major illness medical insurance has achieved its goal of full-coverage, the discrepancy of economic development level and the non-balanced development strategy in various areas, there is no unified mode of the system. The author gives a comprehensive analysis of the system by comparing the financing systems, the protection mechanism and the management services among 31 provinces.The fourth chapter is the effects of the major illness medical insurance——a case study of Zhejiang, Qinghai, and Anhui. Considering the system is not uniform, the data is difficult to collect, and the evaluation standard is difficult to make and so on, the author selects three typical areas to illustrate the forth problem instead from the national level. On one hand, this paper gives evaluation on the system's effects in terms of the social and economic development level, the implementation situation of the basic and the serious illness medical insurance of the three typical areas. On the other hand, the author summarizes the actual operation of the system some existing problems, including the design of the system itself is defective, there are obstacles in the long-term cooperation with the insurance company, and the collaborative propulsion mechanism is inadequate.The fifth chapter, putting forward the countermeasure and suggestions, is the last chapter. Concerning of the problems mentioned above, the author sets forth three aspects as optimizing the system design, building up the long-term mechanism with the insurance company and improving the collaborative propulsion mechanism to perfect the system. For optimizing the system design, the government should take measures to optimize the operating mechanism, to reasonably determine the insurance range and the protection level, and to raise the overall plan level. For building up the long-term mechanism with the insurance company, the government needs to be strictly restricted access threshold and properly prolong the service time. For improving the collaborative propulsion mechanism, the related bodies should work together.The possible innovative ideas in this research are as follows:Currently there are a lot of academic discussions of the major illness medical insurance in area of social security, therefore the selection of subject is highly practical. Besides, this article creatively divides the system into three stages and uses the latest data to analyze the three cases selected before, which will enrich and innovate the research. Finally, this paper has tracked the implementation plan in31 national pilot provinces of the urban and rural residents' major illness medical insurance, so it is empirical to some extent.