An Analysis On The Effect For Major Illness Medical Insurance For Residents Both In Rural And Urban Areas In Shaanxi

The high cost of medical care resulting from major illnesses,often referred to catastrophic medical expenses is the key to causing the masses to "get sick by illness and return to poverty due to illness".Under the basic conditions of China's aging population,aging population and the shortage of per capita medical resources,Urban and rural residents with relatively low overall income face more severe medical burdens and risk of poverty due to illness when they suffer from major diseases.Based on this,China began to explore the establishment of a serious illness insurance system for urban and rural residents in 2012,giving urban and rural residents a further compensation arrangements.At present,the serious illness insurance system of urban and rural residents in Shaanxi has been transferred from the pilot stage to the full implementation stage.Using the method of combining theory with practice,this paper chooses the evaluation index of serious illness insurance to make an in-depth evaluation on the implementation effect of serious illness insurance for urban and rural residents in Shaanxi Province.Sum up the experience that the construction of the serious illness insurance system can be popularized in the western region where the per capita income level is low and the risk of poverty caused by illness is high.Pointing out the existing problems and providing feasible solutions.Firstly,this paper defines the related concepts of serious illness insurance for urban and rural residents in Shaanxi Province by means of literature research and theoretical analysis.The method of calculating the core indexes of medical insurance,such as the ratio of medical burden,the variation of the ratio of medical burden,the high medical cost,the compliance medical cost and the benefit rate has been scientifically determined.Secondly,the theory of risk society,fairness and justice,welfare economics and welfare pluralism should be applied comprehensively to select indicators,And use self-examination and expert consultation method to make scientific amendments to evaluation indicators.The secondary indicators of fairness index include starting point equity,process equity,and outcome fairness,The secondary indicators of efficiency include economic efficiency,institutional efficiency and management efficiency,The secondary indicators of sustainability include financial sustainability,platform building sustainability,and policy design sustainability.Under each of the secondary indicators,there are more than three indicators and scientific criteria are given.Thirdly,according to the evaluation index,the paper scientifically evaluates the system construction and implementation of Xi'an,Hanzhong,Baoji and Yan'an in Shaanxi Province from fairness,efficiency and sustainability,and draws the evaluation conclusion.Based on the comparative analysis of different regional systems according to the evaluation indexes,this paper summarizes the achievements and experiences of the pilot areas in Shaanxi Province,and puts forward the remaining problems.Finally,to provide policy recommendations for improving the system.It is found that the fairness,efficiency and sustainability of the serious illness insurance system of urban and rural residents in Xi'an are poor.The serious illness insurance system in Hanzhoung is fairly fair,moderate in efficiency and less sustainable.The fairness and sustainability of the serious illness insurance system in Baoji is poor,Efficiency is better.Yanan has a certain degree of efficiency and sustainability,but its fairness is poor.The overall compensation level is relatively high,The ability to resolve the high medical costs of urban and rural residents is strong.There is obvious cost benefit effect in the cost management of commercial insurance management.It shows obvious fairness in setting up the protection objects.All localities have explored some new policies and methods in light of their actual conditions,It has formed many experiences with reference,reflecting the obvious characteristics of Shaanxi.At present,there are still some problems in the serious illness insurance system,such as Unreasonable standard setting of high medical expenses;The effect of urban and rural co-ordination in improving fairness is not obvious;The management cost is unreasonable and lacks incentive mechanism;Financing channels are single;The level of information construction is lagging behind.In view of the above problems,this paper puts forward some concrete and feasible countermeasures,such as consolidating universal medical insurance,establishing scientific financing mechanism for catastrophic disease insurance,and providing managerial expenses by the government.Providing guidance for the improvement of serious illness insurance policy in Shaanxi.