| Since China entered the ranks of aging countries in 2000,the proportion of the population over 65 years old increased from 6.9% to 11.4% in 1999-2017.The rising proportion of the elderly population has brought about a series of medical and oldage care problems,causing the state to pay attention to the medical and old-age care problems of the elderly population.At the national level,the aging population means that the proportion of the groups that contribute to medical insurance is constantly shrinking,and the number of groups that can enjoy medical security without further payment is increasing.In other words,the groups that contribute to medical insurance are facing higher and higher intergenerational pressure of medical expenses and greater operational pressure on the basic medical insurance fund.At the level of the elderly,the income level after retirement drops sharply,and they are faced with a higher disease rate,especially in the case of chronic diseases.The prevalence rate of the elderly over 65 years old is 3.2 times that of the whole population,and the hospitalization rate is 2.21 times that of the whole population.That means the elderly face a higher gap in medical costs than the general population.Considering that China’s current medical security system does not have an independent medical system for the elderly,this paper based on the characteristics of medical expenses of the elderly,believes that the medical insurance for serious diseases of urban and rural residents,as a supplement to the basic medical insurance,is consistent with the needs of the elderly who are prone to high medical expenses.At the same time,China’s medical insurance for major diseases for urban and rural residents has been piloted nationwide since 2012,and many local governments have been operating well or even slightly in surplus,starting to improve the system and constantly optimize the compensation design.Therefore,this paper combines the medical needs of the elderly with the medical insurance for serious diseases of urban and rural residents,and suggests that the medical insurance for serious diseases of urban and rural residents should make a system design that is inclined to the treatment and security of the elderly,so as to share the pressure of basic medical insurance and improve the medical security level of the elderly.In this paper,Shandong province is selected as the object of skewed study.Based on the fact that Shandong province has the largest elderly population in China and its ratio of aging has been leading the national average level,it is of greater significance to skew to the elderly population.The medical insurance for serious diseases in Shandong province is provincial-level pooling on the basic medical insurance for the unified residents in urban and rural areas,which has inherent advantages for the system reform.So based on the China health and retirement survey data(CHARLS)2015 in Shandong province as the object of empirical analysis,this paper through the Shandong province has seen a recent months of outpatient service and the latest outpatient expenses as analysis object,verify age factors significantly impact on the outpatient service utilization and medical cost,and through the age range were divided into significance test of outpatient expenses get according to the age limit of age to distinguish the compensation standard,the optimal age of 65.On this basis,the hospitalization expense reimbursement is the main method for major illness insurance.The most recent hospitalization expense of the group aged 65 and above in Shandong province is taken as the object for characteristic analysis.Then,the starting payment standard of major illness insurance for the elderly aged 65 and above is controlled within the annual per capita disposable income of this age group.The per capita out-of-pocket expenses of the elderly aged 65 and above are controlled within the annual per capita disposable income of that age group.The design principle is based on these two conditions.The optimal skew design was obtained for the aged population over 65 years old.In view of the greater fund operation pressure brought by the preferential policy,the cost control is carried out by referring to the medical insurance system for the elderly abroad.The paper is divided into six chapters.Chapter 1 mainly introduces the research background,the purpose and significance of the research,the research summary,the research content and methods,the innovation and deficiencies of this paper.Chapter 2 Outlines the medical insurance system for serious diseases for urban and rural residents in China.This chapter is divided into two sections.The first section is the development process of serious illness medical insurance for urban and rural residents in China.2014-2017 national promotion;From 2018 till now,it is the stage of adjustment and upgrading.The second section is the development status of serious illness medical insurance for urban and rural residents in China,which is respectively summarized from two aspects of adjustment and innovation cases of serious illness medical insurance policy for urban and rural residents and cases of skewed design of serious illness insurance.Chapter 3 is the typical analysis of the medical insurance of serious illness for urban and rural residents in Shandong province.This chapter mainly talks about the system and regional characteristics of medical insurance for serious diseases of urban and rural residents in Shandong province.Shandong province,as the first province in China to realize the integration of urban and rural basic medical insurance,is also established on the basic medical insurance of urban and rural unified medical insurance for major diseases.Moreover,the policies of the whole province are unified,without the implementation of municipal pooling.For the adjustment of medical insurance policy for urban and rural residents with serious diseases,a lot of resistance has been reduced.In addition,Shandong province not only provides medical insurance for major diseases for the participants of basic medical insurance for urban and rural residents,but also provides medical insurance for major diseases for the participants of basic medical insurance for urban and rural workers.However,the two medical insurances for major diseases are operated separately.Chapter 4 analyses the necessity of tilting the medical insurance for serious diseases to the aged population.This chapter mainly verifies that the elderly group needs preferential treatment from three aspects: population aging,income level of the elderly,and data characteristics of medical loss of the elderly.Firstly,it verifies the positive growth effect of population aging on the total medical and health expenses,and the elderly population faces greater medical needs.Secondly,it is verified from the income level of the elderly that the per capita income level of the elderly is lower than that of the whole population,and the same medical expenditure is more economically stressful for them.Finally,respectively is the last month has seen outpatient service,the latest outpatient expenses two variables,the generalized linear model of Logistic,normal regression to verify the age of two variables are significant.The age group with the most significant influence on medical expenses was obtained through cost regression.Chapter 5 feasibility analysis of tilting medical insurance of urban and rural residents to elderly population.This chapter verifies the feasibility of tilting medical insurance from three aspects: the advantage of medical insurance for serious illness of urban and rural residents in protecting the medical loss of the elderly,the operation situation of medical insurance for serious illness of urban and rural residents in Shandong province,and whether the tilting arrangement is fair.First of all,in the event of a serious illness in the elderly after the economic pressure so it’s easy to spend their endowment money,all of a sudden to let them into a prosperous,Secondly,the starting and paying line of serious disease insurance only takes the annual per capita disposable income of urban residents or the annual per capita net income of rural residents as the starting and paying standard,for the elderly are not fully fit their needs.Thirdly,although the per capita capital raised for serious illness medical insurance for urban and rural residents in Shandong province has increased year by year,it is still at a relatively low level and there is still room for optimization.Finally,as a social security,the medical insurance for urban and rural residents with serious diseases has the function of income redistribution,which can make up for the problem that the elderly group with low income is facing greater medical expenditure.Chapter 6 is the countermeasures to improve the inclines of serious illness insurance to the old people’s security--taking Shandong province as an example.This chapter is divided into two parts,the first part is the system design of the elderly security tilting,the second part is the sustainable development countermeasures of the elderly security tilting.In the first part,the author designs the ratio between the minimum payment line and the annual per capita disposable income of the people over 65 in terms of controlling both the minimum payment line and the per capita out-of-pocket expenses.The second part studies the countermeasures of sustainable development from the perspective of government and commercial insurance companies.The innovation of this paper is to improve the level of medical security for the elderly in China by making use of the medical insurance for serious diseases of urban and rural residents to give preferential treatment to the elderly,so as to extend China’s basic medical insurance system from basic insurance and extensive coverage to key assistance.In terms of specific practices,the significance of medical expenses was differentiated according to different age groups,and the most significant difference in medical expenses was obtained between the two age groups in Shandong province with 65 years old as the age limit,and the idea of preferential treatment security was proposed based on this.The deficiency is that the sample data(CHARLS2015)adopted in this paper is lagging behind in years and the sample size is not large enough,so the obliquity basis and obliquity design obtained will deviate from the real situation.This paper mainly studies the method and idea of obliquity for the elderly,and the specific measures still need to be designed according to the real data. |
PDF Full Text Request