Research On The Sustainable Payment System Of Basic Medical Insurance For Urban And Rural Residents

The integration of basic medical insurance for urban and rural residents is the specific goal of establishing and improving the basic medical insurance system covering urban and rural residents in China's new medical reform plan,so as to achieve basic medical insurance for everyone.The level of medical insurance protection is a concentrated reflection of the effects of the medical insurance system,and the stable funding standards and the corresponding compensation levels directly reflect the medical insurance's ability to pay for health risks.On the one hand,the fund deficit risk of the basic medical insurance for urban and rural residents makes the system integration face huge risks,and the dynamic adjustment mechanism of the current funding standards and individual payment levels is not yet perfect.The unreasonable division of the funding structure has resulted in a weak sense of residents' health insurance A series of problems such as low treatment levels;on the other hand,the solvency of medical insurance directly reflects the protection effect of the medical insurance system,and the reform of payment methods during the integration process is immature,and the actual level of payment cannot meet the medical needs of insured persons.The compensation mechanism for major diseases has not yet been perfected,and the tiered diagnosis and treatment policies and compensation responsibilities of designated medical institutions have not yet been implemented,all of which have put forward new requirements for the improvement of the urban and rural basic medical insurance system.This study researches and collects relevant documents such as domestic and foreign professional journals,websites and other research on designing basic medical insurance systems for urban and rural residents,and conducts inductive analysis of the literature to obtain research related information on basic medical insurance systems for urban and rural residents.The statistical analysis data of the data calculation part come from China Statistical Yearbook,Local Statistical Yearbook,China Health Statistical Yearbook,China Health Finance Annual Report,and quantitative data of local finance and tax bureaus,which collected basic medical insurance protection and financing for urban and rural residents from 2015 to 2017.The data and fund income and expenditure data,the number of people insured and the per capita income,compensation ratios and policy data from the local government issued government work reports and policy documents.The study analyzed the basic medical insurance policy practice of urban and rural residents in the Yangtze River Delta region from 2015 to 2017,and assumed four funding standards from high to low,and their adaptability to the compensation level.Based on this,the data of the three years closest to the integration of medical insurance for urban and rural residents was used to calculate the funding standards and payment levels for the next 30 years using multi-factor sensitivity analysis.In the analysis,the basic medical insurance data of urban and rural residents in each region of the Yangtze River Delta in 2017 was used as the main sample to determine how to design a reasonable payment scheme under the operation of the integrated system and maximize the benefit level of the insured residents,achieve reasonable cost control,and reduce the burden of payment.Exploring sustainable funding standards and appropriate adjustments to payment levels,establishing a dynamic fee determination mechanism,setting reasonable payment levels to achieve control of medical expenses,reforming and improving the medical insurance system,establishing a market economic system,and deepening medical fee health One of the important tasks of the cause is to improve and develop universal medical insurance under the new normal of economic development.It is the only way to integrate basic medical insurance for urban and rural residents in the Yangtze River Delta region and the country as a whole,and to safeguard the vital interests of the broad masses of the people and social stability.