Research On Optimizing Urban Basic Medical Insurance System Based On SD Method Under Aging Population

ObjectiveThe aging of population has experienced a heavy process in China,as a result,the cost of medical care for patients has grown rapidly and medical insurance payment problem has been severe.This paper aimed to analyze the influence factors on medical costs and medical insurance payment ability under the background of aging population,build a system dynamics(SD)model that may provide a contribution in urban basic medical insurance field,enabling us to forecast future trends of the system behavior and analyze the influence of some possible policy interventions on system behavior change,to help managers make effective decisions to effectively reduce the medical burden and ensure a balanced operation of the medical insurance.MethodsData were collected from China Health Statistics Annual Reports,China Statistical Annual Reports and Health Statistics Abstract 2007-2014,such as the urban basic medical insurance fund,fee per time in outpatient and hospitalization,the number people who participated in the urban basic medical insurance.We used literature review to analyze the influence factors on medical costs and medical insurance payment ability,used system analysis method to analyze system modeling target,structure and environment,determine system border and concept model.We then used causal loop diagram and stock-flow diagram to describe the logical relations between system elements,build logic model.And we used system dynamics method to build system model.the SD simulation model was simulated through the use of Vensim DSS 5.6a.ResultsWith the aging of population,medical care costs tended to rise yearly in China,the growth rate is higher than the total health expenses,being out of economic growth level,and brought heavy pressure to medical payments.However,the actual reimbursement ratio was low in the urban basic medical insurance,persons have heavy medical burden.Since 2003,the growth rate of urban basic medical insurance fund expenditure basically higher than income,paid big pressure.Factors affecting medical costs and medical insurance payments included society,economy,population,national policies,health system and so on,as well as the main body including the government,medical insurance department,medical institutions and people participated in medical insurance.Urban basic medical insurance fund income and expenditure tended to rise year-on-year without any intervention,expenditure grew more than income after 2020 and the later was more obvious,medical insurance fund surplus tended to reduce yearly,reaching-239.6 hundred million yuan in 2025.There was a general tendency toward rising in medical costs,the urban employees medical costs reached 63145.0 hundred million yuan in 2025,and the urban residents medical costs reached 36623.0 hundred million yuan.Individual self-paid medical costs tended to rise yearly under imperfectness of medical insurance system and lower reimbursement ratio,medical costs per year paid by people who participated in the urban employees basic medical insurance were 1599.0-6357.0yuan in 2007-2025,and participated in the urban residents basic medical insurance were 497.5-4916.0yuan.The model simulations showed that carrying out the policy of health insurance fees paid by the retired employees,reducing population support rate,improving government funding on the urban residents medical insurance can be effective ways to add the urban basic medical insurance fund and delay time fund surplus began to decrease.Also,improving the proportions of the outpatient and hospitalization in community medical institutions,and cutting down the growth rate of fee per time can decrease individual self-paid medical costs and delay time fund surplus began to decrease.In addition,with the implementation of unified planning in outpatient service,the decrease of the start standard to pay fees,and the improving of highest pay limitation as well as reimbursement ratio,individual self-paid medical costs decreased.The comparison of the several experiments suggested that the policy of health insurance fees paid by the retired employees,reducing population support rate and cutting down the growth rate of fee per time were better tools than improving government funding and proportions of the outpatient and hospitalization in community for decreasing individual self-paid medical costs and ensuring a balanced operation of the insurance.ConclusionsUrban basic medical insurance fund income and expenditure,medical care costs,as well as medical costs per year paid by people who participated in the insurance tended to rise year-on-year,and fund surplus tended to reduce yearly,in the next years would be negative.Thus several interventions may be effective in decreasing individual self-paid medical costs,alleviating payment pressure of the fund and ensuring a balanced operation of the insurance,including carrying out the policy of health insurance fees paid moderately by the retired employees,delaying retirement age,increasing government funding on the urban residents medical insurance,pushing the tiered medical services based on community first-visit practice and two-way referral system,as well as implementing unified planning in outpatient service,and improving the reimbursement ratio.