The Study On The Operation Mechasim Of The Insurance In Shanxi Province

The major illness insurance for urban and rural residents is an extension and expansion of basic medical insurance.It is an important guarantee system for preventing urban and rural residents from becoming poor due to illness and returning to poverty due to illness.At present,China's major illness insurance is guided by welfare pluralism theory,quasi-public product theory and public choice theory.It introduces market mechanism and operates in the way of government-led and commercial insurance institutions.Its financing comes from the payment of basic medical insurance funds.Does not increase the burden on the insured person to pay additional fees.As a new thing,in 2012,China's major illness insurance began to be piloted nationwide and gradually promoted.In actual operation,local governments have formulated different policies in light of their own actualities.Shanxi Province launched a pilot program for major illness insurance in 2013 and was fully implemented in the province in 2015.Since the implementation,the scope of protection has covered most of the basic medical insurance participants in the province,reducing the heavy economic burden of the insured person's medical expenses for major illnesses.Although the urban and rural residents' major illness insurance system has been rapidly established in Shanxi Province,there are still many problems in its operation mechanism in the specific operation process.This paper collects and collates relevant literatures on the operation mechanism of major illness insurance at home and abroad,selects the operation mechanism of major illness insurance in Shanxi Province as the research object,conducts on-the-spot investigation and visits to the insurance company that undertakes the major illness insurance of Shanxi Province,and obtains relevant information from Shanxi Province.The operational mechanisms of the major illness insurance policies,financing mechanism,operating mechanism,profit mechanism and supervision mechanism are sorted out and studied.Through the research on the operation mechanism of major illness insurance in Shanxi Province,it is found that there are few financing channels,low level of coordination,lack of coordination among various departments,lack of profit guaranteemechanism,frequent medical problems,lack of use of big data,etc.problem.These problems are mainly caused by the fact that the major illness insurance is too dependent on the basic medical insurance fund,the insurance company lacks relevant operational experience,and the bidding mechanism is not perfect.In view of the existing problems,this paper introduces two domestic operating experiences of Zhanjiang model and Taicang model.It also introduces the mature system and operational experience of major illness insurance in the United States,Britain and Germany,and proposes a perfect fundraising system,strengthens departmental cooperation,and improves “guarantee”.The profit mechanism of“micro-profit”,strengthening medical risk management and control,realizing the docking and sharing of medical data and data mining suggestions,promote Shanxi Province to continuously explore more scientific and effective operation mechanism.