Research On The Problems And Improvement Strategies In The Operation Of The Serious Illness Insurance System In Lucheng District

Serious illness insurance promotes the reform of medical system.For the insured people who suffer from serious illness and become poor due to illness,it reduces the high medical burden of most of the poor people,improves the level and coverage of social security,and enriches the connotation of social insurance and supplementary medical insurance.It can be estimated that in the process of promoting serious illness insurance in the future,the problem of local implementation of serious illness insurance will gradually emerge.In this paper,through literature research and,we can understand and analyze the operation of serious illness insurance.The writer based on the summary of domestic and foreign theoretical and practical research results,combined with the concept and theoretical basis of serious illness,this paper studies the current situation of the implementation of serious illness insurance in Lucheng District,finds problems such as narrow income range,single and unsustainable financing mechanism,uncoordinated operation and management,and weak supervision,and puts forward the ideas and feasibility of promoting the development of serious illness insurance in Lucheng District,Wenzhou City,combining with domestic and foreign experience.It is suggested that we should improve the fund-raising and fund-raising situation by improving the benefit coverage,expanding the coverage and improving the benefit situation,innovating the fund-raising mechanism and the single disease payment mechanism,improving the cooperation between the government and the insurance company,improving the work efficiency,strengthening the policy propaganda and guidance to enhance the operation service efficiency,and strengthening the supervision by the diversified supervision mechanism and dynamic mechanism.Therefore,serious illness insurance system in Lucheng is a policy for the benefit of the people,which is based on the medical insurance,led by the government and undertaken by the insurance company,and reasonably and effectively reduces the expenditure of major diseases.Since 2015-2018,serious illness insurance in Lucheng District has been in operation,and the unified management of employees and urban and rural residents has been realized in the insured groups;in terms of the scope of insurance,the protection of serious illness insurance system in disease types and high-value drugs has been explored,and the level of benefit protection has been detailed according to the regional GDP standard.At the same time,the method of interval compensation proportion is worth affirming,but the scope of protection and the inclination of protection should be adjusted in real time,In terms of medical level,we should appropriately expand the categories of beneficiary diseases and guarantee drugs,and propose to realize thenational integration catalog;in terms of financing,Lucheng District's financing should be slightly adjusted between 2015 and 2018 according to the regional level,but the fund source is too single,and all of it comes from financing,so it is necessary to reasonably and actuarially raise funds,scientifically formulate standards,and ensure the balance of income and expenditure;in terms of handling and operation,Lucheng District should The district's tedious handling process has been optimized to a certain extent.Through "payment mode reform" and "information-based health insurance supervision",the expenditure of health insurance fund is controlled.The service incentive reward and punishment system of insurance companies can be continuously improved and strengthened through the audit responsibility system,commission fee payment system,service assessment system and other methods.The government,as the leader,should give effective and reasonable publicity policies in order to better help the operation of insurance companies;in terms of supervision and management,the fund supervision mechanism of Lucheng District is single and slightly weak,which needs to be strengthened in terms of mechanism and configuration.The medical insurance institutions in the jurisdiction supervise by various means,while the commercial insurance companies undertaking serious illness insurance should self-examine and establish a supervision mechanism to ensure the safe and healthy operation of serious illness insurance.