Evaluation Of The Impact Of Basic Medical Insurance On Medical Services In China

Objective:To understand the status of the basic health insurance system in our country,analyze the impacts of basic medical insurance on medical services,evaluate the effectiveness and problems of basic medical insurance in medical services,and make some solutions to improve the basic medical insurance system and give full play to the role of medical insurance in medical services.Methods:1.Literature research method:combing the role of basic medical insurance in medical services,and in-depth analysis of China's basic medical insurance and its impact on medical services.2.Comparative analysis:horizontally compare the impact of the three basic medical insurance on medical service utilization,medical service costs and patient satisfaction,compare the current status of basic medical insurance in vertical time and its effect on medical service leverage,supervision and control Impact.3.Function-oriented approach:Functionally-oriented assessment of the impact of basic medical insurance on medical services.4.Rank-sum ratio comprehensive evaluation method:Calculate the RSR value and RSR distribution of basic medical insurance and medical services separately,and evaluate the relationship between basic medical insurance and medical services by using Spearman rank correlation.Results1.Basic medical insurance operation:In 2011-2016,the number of participants in the three basic medical insurance increased from 1.305 billion to1.344 billion,and the per capita financing of urban workers'medical insurance increased from 2031 to 3544 yuan,and the per capita financing of residents'medical insurance increased from 246 yuan to 590 yuan.The government's per capita financial subsidies for residents'medical insurance increased from 184yuan to 442 yuan,and financial subsidies accounted for 3/4 of the total per capita fundraising;in 2016,the proportion of hospitalization expenses within the scope of employee medical insurance policy was 81.7%,and the resident medical insurance reached 65.8%.The payment for the urban basic medical insurance fund was maintained at around 18 months,and 88%of the three-level fixed-point medical institutions were connected,and the proportion of the payment for the foreign medical insurance fund reached 58.8%.2.Evaluation of“performance”:In 2011-2016,the number of designated medical institutions in China increased from 97,760 to 144,924,of which the number of designated medical institutions in the grassroots organizations increased from 76,594 to 120,712.In 2014,medical insurance expenditure accounted for 52.1%of the total income of hospital business.68.2%of medical insurance funds flowed to three-level fixed-point medical institutions,30%to secondary fixed-point medical institutions,and 1.8%to primary medical institutions.3.Function-oriented assessment:In terms of leverage,the proportion of hospitalized medical insurance patients in urban hospitals,county medical institutions,municipal medical institutions,and provincial hospitals was 6.7%,45.4%,31.2%and 14.9%in 2013.The urban residents'medical insurance accounted for 11.4%,53.4%,23.4%and 8.5%respectively.Among them,the proportion of hospitalization in the county level was increased,and the hospitals were above the city level and above.The proportion decreased,and the rate of hospitalization increased significantly faster than the average outpatient visit.In terms of regulatory role,80%of the country's regions launched the medical insurance intelligent monitoring system in 2016,and the efficiency of medical insurance supervision has been improved.In terms of the role of fee control,in2011-2016,the medical insurance medical expenses increased from 4353 to8764 yuan,and the cost growth rate decreased from 21.7%to 11.1%,but the growth rate was still higher than the GDP growth rate?6.7%?.4.Effects of three basic medical insurances on medical services:In terms of outpatient service utilization,urban workers'medical insurance,urban residents'medical insurance,and new rural cooperative medical insurance?hereinafter referred to as“three basic medical insurances”?are insured The rate of treatment for doctors was 33.4%,19.4%,and 16.4%,respectively,and the proportion of untreated patients was 33.4%,0.4%,and 2.5%.In terms of inpatient service utilization,the number of hospitalizations for the three basic medical insurance participants accounted for 84.2%,81.6%,and 81.9%,respectively.The proportion of hospitalizations required to be hospitalized was 15.8%,18.4%,and18.1%.In terms of hospitalization expenses,the three basic medical insurances were paid at a rate of 3,888 yuan and 4,644 respectively.Yuan and 3309 yuan,the second-time self-paying accounted for 16.7%,30%and 33%of the family's per capita annual income,respectively.In terms of satisfaction,the new rural cooperative medical care participants had the highest satisfaction,and the outpatient and inpatient satisfaction rates reached 81.1%and 71.7%,respectively,while the urban workers and residents'medical insurance satisfaction was relatively low,among which the urban employee medical insurance participants were outpatients.The hospitalization satisfaction rate was 73.2%and 59.8%,respectively,and the urban residents'medical insurance participants were 72.9%and 63.3%,respectively.5.Comprehensive assessment results:The average value of medical service in each province was 0.5152,and the variance was 0.1204.The mean value of medical insurance was 0.5161,and the variance was 0.1211.Spearman rank correlation results r_RSR=0.2215,r_{RSR distribution}=0.206?P>0.05?Conclusion:The basic health insurance has been fully covered,the per capita level of funding and payment has increased yearly,and the problem of out-of-town medical treatment has been basically solved.Meanwhile,basic medical insurance has also played a role in the leverage,supervision and control of medical services.However,the unbalanced development of medical insurance and medical services remains a serious problem,the sustainability of the medical insurance system still faces great challenges,the problem of"expensive medical treatment"still exists,and the incentive effect of medical insurance on medical services is weak.Lack of authority on medical regulation,the division of"three doctors",each of them has a weak link to politics.