| Since the State Council issued the Opinions on the Integration of the Basic Medical Insurance System for Urban and Rural Residents in 2016,the integration of the basic medical insurance system for urban and rural residents in China has been nearly five years.Although the basic medical insurance system for urban and rural residents has overcome some problems before the integration of the basic medical insurance for urban residents and the new rural cooperative medical system,it is still not fair enough and inefficient in the process of operation.This article is based on Arthur Okun choice point of view of efficiency and fairness,the author worked as an intern in Hubei province medical insurance bureau of thought,thought,to think,to improve urban and rural residents basic medical insurance system in China as the research object,through the study consummates our country urban and rural residents basic medical insurance system,improve system integration after the fairness and efficiency.This thesis respectively from the eastern,central and west and provincial level measure of fairness and efficiency,the measure of the fairness based on the analysis of the basic indexes,the Gini coefficient and Theil index analysis three kinds of evaluation methods,reference literatures to the fairness of the basic medical insurance system for urban and rural residents in time sequence is divided into fair starting point and fair procedure fairness and result,this comprehensive study the fairness of the urban and rural residents basic medical insurance system in China.Based on the basic medical insurance system for urban and rural residents basic on the premise of fair measure of the efficiency,using data envelopment analysis（DEA）to measure 2017 26 provinces（municipalities and autonomous regions）to "the unity of" the second confirmed the efficiency of the basic medical insurance system for urban and rural residents,according to the result of regional efficiency measure and policy characteristics put forward the measures of improving efficiency.According to the results of equity and efficiency measurement,this thesis provides some suggestions for different provinces（municipalities and autonomous regions）to improve efficiency on the basis of giving priority to equity.The main conclusions of this thesis are as follows:First,China’s basic medical insurance system for urban and rural residents is generally fair.There have been improvements to varying degrees in the starting point equity of health institutions and the distribution of beds,the process equity of the utilization of admission medical resources and the outcome equity of residents’ health degree.The fairness difference of the basic medical insurance system for urban and rural residents in China is mainly caused by the differences within the eastern,central and western regions,and the central region has a higher fairness overall.The western region needs to improve the fairness of medical resource allocation,the fairness of individual financing amount and the fairness of inpatient medical service utilization,and strive to narrow the differences in the health level of residents between the western provinces.The eastern region needs to pay attention to the use of outpatient resources in the region,so as to improve the health equity of residents in the region.Second,the basic medical insurance system for urban and rural residents in Heilongjiang,Zhejiang,Jiangxi,Shandong,Henan,Hunan,Guangxi,Guizhou and Yunnan is effective in nine of the 26 provinces（municipalities directly under the central government and autonomous regions）that implemented the "two-in-one" basic medical insurance scheme in 2017.Through sorting out the local policies,we found that more than 50% of the areas with effective systems have the following commonalities: first,the coverage covers all urban and rural residents except the employees who participate in the basic medical insurance;Second,most of the financing policy for the provincial unity and a system;Third,the level of medical insurance treatment for urban and rural residents has been unified or is gradually being unified;Fourth,the province’s unified medical insurance directory;Fifth,the medical insurance fund for urban and rural residents shall be merged with the new rural cooperative medical care fund for urban and rural residents,and the gap of the combined fund shall be solved by local governments.Sixth,the overall planning level is the municipal overall planning,which is managed by the human resources and social security departments.Third,the central region with the best fairness of the basic medical insurance system for urban and rural residents also has a high efficiency,which indicates that the basic medical insurance system for urban and rural residents can achieve the "double high" state of fairness and efficiency through system improvement.It needs to be specially pointed out that in the process of system improvement,different treatment is needed: regions with low equity should be given priority to improve their equity;Areas with high equity can give priority to trying to improve efficiency.The innovation of this thesis is as follows: firstly,the existing research is mostly focused on the country and a specific province,and the research of this thesis is based on the provincial level,which makes up for the deficiency of this research.Secondly,combining the western theories and China’s national conditions,it innovatively proposes that the improvement of China’s basic medical insurance system for urban and rural residents should give priority to the fairness of opportunities and then consider the improvement of efficiency.The deficiencies of this thesis are as follows: First,the latest official data is only related to the basic medical insurance for urban and rural residents in 2017,and the policy suggestions may lag behind.Second,there is a deviation between the municipal pooling level and the regulations,and the data is difficult to be accurate to the municipal level. |
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