Study On The Current Situation Of Municipal Overall Planning Of Basic Medical Insurance In Anhui Province

Objective:In order to implement the spirit of national medical system reform and promote the safe and sustainable operation of basic medical insurance at the municipal level.This paper analyzes the "six unifications" of urban workers’ basic medical insurance and urban and rural residents’ basic medical insurance at the municipal level in recent ten years and nearly six years in cities A,B and C of Anhui Province.To find the problems and reasons existing in the process of municipal overall planning of basic medical insurance in Anhui Province,and put forward targeted and forward-looking countermeasures by drawing lessons from the experience of overall planning of medical insurance at home and abroad.Then it can better promote the process of municipal overall planning of basic medical insurance,improve the treatment level of medical insurance,improve people’s satisfaction,and lay a solid foundation for provincial overall planning and even national overall planning of medical insurance in the future.Methods: Through the availability and integrity of data and expert recommendation,this paper selects B city in southern Anhui,A city in central Anhui and C city in Northern Anhui as empirical research areas,and designs relevant data tables and interview outlines.According to the data and policy documents consulted online and actually collected,combined with relevant literature research,excel 2017 is used to analyze and sort out the data and materials.Through the analysis and comparison of the operation of urban workers’ medical insurance and urban-rural inhabitants’ medical insurance municipal planning in Anhui Province and sample areas,we can understand the difficulties and reasons faced by the municipal planning of basic medical insurance in Anhui Province.Results:（1）In terms of insurance coverage,the number of urban employees in Anhui Province and the three sample areas raised year by year,and the number of urban-rural inhabitants reduced slightly.On the whole,the total number of insured persons of basic medical insurance in Anhui province fluctuates up and down and develops slowly.The insured rate reached 109.82% in 2020.The total number of insured persons in the three sample areas decreased from 2015 to 2019 until 2020.Except Wuhu,the insured rates of A city and C city are higher than the average level of Anhui Province.（2）From the respect of fund working: the operation of the medical insurance fund for urban workers in Anhui Province and the three sample areas is relatively stable.Only A city has a slight decline in the medical insurance fund for urban employees in 2020.The grand total remaining sum of the medical insurance fund for staff and workers in Anhui Province has an average annual growth rate of 17.75%,and the number of payment months in 2020 was 22.72 months.There are some challenges in the work of the medical insurance fund for urban-rural inhabitants.comprehensive analysis shows that the growth rate of the expenses of the fund for urban-rural inhabitants in Anhui Province and the sample area is greater than the growth rate of income.Since 2018,the expenditure of the medical insurance Fund for urban-rural inhabitants in Anhui Province,A city and C city has exceeded the income.The number of months that the medical insurance fund for urban-rural inhabitants can pay in Anhui Province in 2020 is only 6.31 months,It is not as good as the mutual aid ability of the medical insurance fund for urban employees.（3）From the perspective of treatment payment: the level of hospitalization treatment for urban employees and urban-rural inhabitants in Anhui Province is higher than before,and the payment of hospitalization treatment of medical insurance is slightly different in various cities.In the payment level of medical insurance hospitalization treatment for urban employees in the sample area,the starting line of A city and B city has little change,and the capping line is low,with A city 70000 yuan and B city 30000 yuan,and the reimbursement proportion is between 85%-96%.The starting line of C city is relatively high,and the ceiling line is up to 250000 yuan,with an reimbursement rate of 84%-95%.In the payment level of medical insurance hospitalization treatment for urban-rural inhabitants in the sample area,the starting line is the same.Due to the interval division,the reimbursement proportion of A city is slightly lower than that of B city and C city.The ceiling line is250000 yuan,which is also lower than that of B city and C city.In the three sample areas,the starting line of medical insurance for urban employees is higher,equal to and lower than that for urban-rural inhabitants.In terms of reimbursement ratio,the medical insurance for urban staff and workers is generally higher than that for urban-rural inhabitants,and the medical insurance for urban employees on the capping line is generally lower than that for urban-rural inhabitants.（4）From the perspective of fund supervision,the effectiveness of fund supervision in various cities is remarkable.Through joint supervision,intelligent supervision,third-party supervision and other means,the supervision ability has been enhanced and the supervision level has been improved.（5）From the perspective of handling management and information system,all localities and cities actively promote unified handling processes and standards,improve handling service level,and simplify off-site medical treatment procedures.Accelerate the construction of medical insurance information system,realize the sharing of medical insurance data among medical related departments,create a convenient and efficient medical insurance service platform,and strive to realize the unified medical insurance information system of the whole province as soon as possible.（6）From the perspective of municipal overall planning mode,A city implements the mode of unified revenue and expenditure and hierarchical management;B city is exploring and implementing the mode of unified revenue and expenditure and vertical management;C city adopts the mode of adjusting funds,unified collection and expenditure and hierarchical management.Conclusion: Anhui Province has made some achievements in promoting the municipal overall planning of basic medical insurance,but there are also some problems.Two medical insurance management methods affect the overall planning of national medical insurance,the municipal overall planning mode of medical insurance is not unified,the coordination efficiency of management departments at all levels is not high,the operation risk of medical insurance fund for urban and rural residents is high,and the phenomenon of unreasonable distribution of medical resources appears.Through the analysis,we know that the causes of the problems lie in the dispersion of medical insurance system design and management system,the imbalance of regional economic development,the difficulty of coordination among functional departments,the dual challenges of financing and aging,and the moral hazard among various stakeholders.In order to effectively alleviate the dilemma of municipal overall planning of basic medical insurance,this paper puts forward some suggestions to optimize the municipal overall planning management of basic medical insurance in Anhui Province by learning from the experience of medical insurance overall planning at home and abroad.For example,unify the management mode of medical insurance and enhance the overall planning ability of medical insurance;Accelerate the unified collection and expenditure and explore the vertical management mode;Clarify the responsibilities and authorities of the Department and strengthen the ability of collaborative governance;Improve the financing sharing mechanism and increase the financing of medical insurance;Improve the internal and external fund supervision system;Rapidly improve the information system and promote the reform of medical insurance payment mode;Actively implement graded diagnosis and treatment and open up a two-way medical channel.