Study On The Impact Of Health Care Alliance Reform On Medical Insurance Fund Expenditure

As the construction of an integrated medical and health service system is increasingly becoming an important part of global medical reform,Primary Health Care(PHC)is increasingly concerned by people,and the focus of China's "new medical reform" is from expanding the coverage of medical insurance to improving the basic level.Health care alliance,as an important unit of primary health care system,not only plays an important role in strengthening the level of primary medical services and improving the efficiency of primary medical services,but also helps to ensure the sustainable operation of basic medical insurance funds.After reviewing the current research on the reform of the health care alliance at home and abroad,few articles have made an in-depth analysis of its internal mechanism and future medical insurance fund expenditure trends.This paper takes the sustainable operation of the medical insurance fund as an entry point,and aims to explore the short-term and long-term effects of the reform of the health care alliance,in order to provide the theoretical basis and relevant policy recommendations to deepen the reform of the health care alliance,strengthen the governance capacity of primary health care,and promote the construction of integrated care service system.This paper is based on the micro data of basic medical insurance from October2015 to June 2018 in R County.On the one hand,by constructing a fixed-effect model,the mechanism of the impact of health care alliance reform on basic medical insurance fund expenditures is analyzed,which explains the short-term impact of health care alliance reform;On the other hand,using the non-life insurance actuarial model and Monte Carlo simulation method to predict the trends of the basic medical insurance fund expenditure in the future 2018-2024,which explains the long-term impact of the health care alliance reform.This paper finds: 1.The health care alliance reform can effectively reduce the pressure of basic medical insurance fund and personal burden,and control the rise of medical expenses.2.The health care alliance reform is conducive to promoting the establishment of hierarchical medical system and enhancing the ability of primary health care governance,accelerating theconstruction of an integrated care system.3.Although the reform of the county medical community has reduced the overall pressure on the basic medical insurance fund,it may have increased the burden of the fund for the insured of the basic medical insurance for rural residents(including the insured of the new rural cooperative medical).4.In the long run,the health care alliance reform will help reduce the total medical expenses,slow down the growth rate of the medical insurance fund expenditure,reduce the risk margin of the medical insurance fund,and ensure the sustainable operation of the medical insurance fund.Therefore,this paper proposes to promote the health care alliance from the unity of legal representatives to the unity of legal institutions,so that the county medical community would become a community of interests in the true sense.Increasing the reimbursement gaps of the differentiated medical insurance policy,and give full play to the leverage of the differentiated medical insurance policy.Promote the reform of medical insurance payment methods and improve relevant incentive measures.Establishing a medical insurance fund risk early warning mechanism,and strengthen the supervision of the medical community.